Healthcare Provider Details

I. General information

NPI: 1326232174
Provider Name (Legal Business Name): FAMILY MEDICINE AND HEALTHCARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 N FEDERAL HWY SUITE C
POMPANO BEACH FL
33062-1032
US

IV. Provider business mailing address

1990 N FEDERAL HWY SUITE C
POMPANO BEACH FL
33062-1032
US

V. Phone/Fax

Practice location:
  • Phone: 954-788-9399
  • Fax: 954-905-4990
Mailing address:
  • Phone: 954-788-9399
  • Fax: 954-905-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberOS7919
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberOS7919
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberOS7919
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberOS7919
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS7919
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM W. CHEATHAM
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 954-788-9399