Family Care Physician Group | |
45669 Highway 27 Davenport FL 33897-4546 | |
(863) 866-2551 | |
(863) 866-2552 |
Full Name | Family Care Physician Group |
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Speciality | Clinic/Center |
Location | 45669 Highway 27, Davenport, Florida |
Authorized Official Name and Position | Lira Lama (DIRECTOR) |
Authorized Official Contact | 4079681755 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Family Care Physician Group 45669 Highway 27 Davenport FL 33897-4546 Ph: (863) 866-2551 | Family Care Physician Group 45669 Highway 27 Davenport FL 33897-4546 Ph: (863) 866-2551 |
NPI Number | 1578016820 |
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Provider Enumeration Date | 08/03/2016 |
Last Update Date | 04/23/2020 |
Medicare PECOS PAC ID | 8921368580 |
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Medicare Enrollment ID | O20180131000806 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578016820 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Nelson A Nieves |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1841327236 PECOS PAC ID: 5395808190 Enrollment ID: I20090105000516 |
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