Provider Demographics
NPI:1689785727
Name:AMERICAN MEDICAL CARE
Entity Type:Organization
Organization Name:AMERICAN MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARI JO
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-868-9563
Mailing Address - Street 1:PO BOX 5477
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34674-5477
Mailing Address - Country:US
Mailing Address - Phone:727-868-9563
Mailing Address - Fax:727-869-6909
Practice Address - Street 1:7315 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1158
Practice Address - Country:US
Practice Address - Phone:727-868-9563
Practice Address - Fax:727-869-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38935OtherBLUE CROSS
FL38935OtherBLUE CROSS
FLCG1789Medicare ID - Type UnspecifiedRAILROAD MEDICARE