Provider Demographics
NPI:1821464082
Name:FAMILY MEDICAL AND WELLNESS CARE, PLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL AND WELLNESS CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-861-8229
Mailing Address - Street 1:4530 E RAY RD
Mailing Address - Street 2:STE 130
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6094
Mailing Address - Country:US
Mailing Address - Phone:480-494-2100
Mailing Address - Fax:
Practice Address - Street 1:2525 W BERYL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-1606
Practice Address - Country:US
Practice Address - Phone:602-424-7967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26147174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty