Provider Demographics
NPI:1750499026
Name:FAMILY CARE MEDICAL GROUP
Entity Type:Organization
Organization Name:FAMILY CARE MEDICAL GROUP
Other - Org Name:EAST FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-737-9989
Mailing Address - Street 1:10244 E COLONIAL DR
Mailing Address - Street 2:STE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4374
Mailing Address - Country:US
Mailing Address - Phone:407-737-9989
Mailing Address - Fax:407-380-3228
Practice Address - Street 1:10244 E COLONIAL DR
Practice Address - Street 2:STE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4374
Practice Address - Country:US
Practice Address - Phone:407-737-9989
Practice Address - Fax:407-380-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97984Medicare ID - Type Unspecified