Healthcare Provider Details

I. General information

NPI: 1194940684
Provider Name (Legal Business Name): FMCM, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 BOGGY CREEK RD
KISSIMMEE FL
34744-3806
US

IV. Provider business mailing address

2551 BOGGY CREEK RD
KISSIMMEE FL
34744-3806
US

V. Phone/Fax

Practice location:
  • Phone: 407-348-0990
  • Fax: 407-944-9041
Mailing address:
  • Phone: 407-348-0990
  • Fax: 407-944-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANA S GAUCHAT
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-348-0990