Provider Demographics
NPI:1689873028
Name:FAMILYCARE OF WESLEY CHAPEL
Entity Type:Organization
Organization Name:FAMILYCARE OF WESLEY CHAPEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROSEQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-948-3838
Mailing Address - Street 1:1942 HIGHLAND OAKS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559
Mailing Address - Country:US
Mailing Address - Phone:813-948-3838
Mailing Address - Fax:813-949-0629
Practice Address - Street 1:5251 VILLAGE MARKET
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544
Practice Address - Country:US
Practice Address - Phone:813-991-6000
Practice Address - Fax:813-973-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53682OtherMEDICARE
FL02510OtherMEDICARE
FLD65093Medicare UPIN
FLD09214Medicare UPIN
FL53682OtherMEDICARE