Healthcare Provider Details

I. General information

NPI: 1588705768
Provider Name (Legal Business Name): FIRST CARE FAMILY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 EBER BLVD STE 101
MELBOURNE FL
32904-8768
US

IV. Provider business mailing address

150 N SYKES CREEK PKWY STE 300
MERRITT ISLAND FL
32953-3488
US

V. Phone/Fax

Practice location:
  • Phone: 321-723-1074
  • Fax: 321-723-1075
Mailing address:
  • Phone: 321-449-4168
  • Fax: 321-449-4164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDI LAROCHE
Title or Position: MSO CREDENTIALING COORDINATOR
Credential:
Phone: 321-449-4168