Provider Demographics
NPI: | 1942840129 |
---|---|
Name: | FAMILY MEDICINE CARE, LLC |
Entity Type: | Organization |
Organization Name: | FAMILY MEDICINE CARE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TROY |
Authorized Official - Middle Name: | ALAN |
Authorized Official - Last Name: | TYNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 937-429-0607 |
Mailing Address - Street 1: | 2510 COMMONS BLVD STE 210 |
Mailing Address - Street 2: | |
Mailing Address - City: | BEAVERCREEK |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45431-3821 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 937-558-3062 |
Mailing Address - Fax: | 937-558-3067 |
Practice Address - Street 1: | 2510 COMMONS BLVD STE 210 |
Practice Address - Street 2: | |
Practice Address - City: | BEAVERCREEK |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45431-3821 |
Practice Address - Country: | US |
Practice Address - Phone: | 937-429-0607 |
Practice Address - Fax: | 937-558-3067 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | INTERNAL MEDICINE CARE, INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2020-01-15 |
Last Update Date: | 2020-01-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |