Provider Demographics
| NPI: | 1871589192 |
|---|---|
| Name: | OCALA FAMILY MEDICAL CENTER, INC. |
| Entity type: | Organization |
| Organization Name: | OCALA FAMILY MEDICAL CENTER, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | LARRY |
| Authorized Official - Middle Name: | W |
| Authorized Official - Last Name: | MAYFIELD |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 352-237-4133 |
| Mailing Address - Street 1: | 2230 SW 19TH AVENUE RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | OCALA |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 34471-1391 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 352-237-4133 |
| Mailing Address - Fax: | 352-237-7728 |
| Practice Address - Street 1: | 2230 SW 19TH AVENUE RD |
| Practice Address - Street 2: | |
| Practice Address - City: | OCALA |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 34471-1391 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 352-237-4133 |
| Practice Address - Fax: | 352-237-7728 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-09-22 |
| Last Update Date: | 2024-01-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207ND0101X | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | Group - Multi-Specialty |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
| No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Multi-Specialty |
| No | 261QR0200X | Ambulatory Health Care Facilities | Clinic/Center | Radiology | |
| No | 291U00000X | Laboratories | Clinical Medical Laboratory | ||
| No | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 97622 | Medicare ID - Type Unspecified |
