Provider Demographics
NPI:1821279597
Name:ADVANCED FAMILY CARE INC
Entity Type:Organization
Organization Name:ADVANCED FAMILY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGUED
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-951-4538
Mailing Address - Street 1:PO BOX 741240
Mailing Address - Street 2:HEALTH LEDGER SERVICES
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32774-1240
Mailing Address - Country:US
Mailing Address - Phone:386-951-4538
Mailing Address - Fax:386-259-3689
Practice Address - Street 1:2836 ENTERPRISE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-5210
Practice Address - Country:US
Practice Address - Phone:386-951-4538
Practice Address - Fax:386-259-3689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI193Medicare PIN