Healthcare Provider Details

I. General information

NPI: 1639346943
Provider Name (Legal Business Name): FMC IPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-780-8440
  • Fax:
Mailing address:
  • Phone: 813-780-1255
  • Fax: 813-780-9773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHANDRESH SARAIYA
Title or Position: MEMBER
Credential:
Phone: 813-783-3118