Provider Demographics
NPI:1821209958
Name:FAMILY PRACTICE ASSOCIATES OF RIVERVIEW LLC
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF RIVERVIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M H
Authorized Official - Last Name:AUGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-236-4100
Mailing Address - Street 1:11347 BIG BEND RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5835
Mailing Address - Country:US
Mailing Address - Phone:813-236-4100
Mailing Address - Fax:813-234-4800
Practice Address - Street 1:11347 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-7183
Practice Address - Country:US
Practice Address - Phone:813-236-4100
Practice Address - Fax:813-234-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH92730Medicare UPIN