Provider Demographics
NPI:1891034823
Name:EXPRESS FAMILY CARE
Entity Type:Organization
Organization Name:EXPRESS FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILANICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:386-698-1221
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32178-0066
Mailing Address - Country:US
Mailing Address - Phone:386-698-1221
Mailing Address - Fax:386-698-1514
Practice Address - Street 1:300 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-2729
Practice Address - Country:US
Practice Address - Phone:386-698-1221
Practice Address - Fax:386-698-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty