MEDICARE: FMCM, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1194940684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FMCM, INCORPORATED

Provider Business Mailing Address
First Line	:	2551 BOGGY CREEK RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-3806
Country	:	US
Telephone Number	:	407-348-0990
Fax Number	:	407-944-9041

Provider Business Practice Location Address
First Line	:	2551 BOGGY CREEK RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-3806
Country	:	US
Telephone Number	:	407-348-0990
Fax Number	:	407-944-9041

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. DIANA S GAUCHAT
Credential	:
Telephone Number	:	407-348-0990

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	03/23/2012

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