Healthcare Provider Details

I. General information

NPI: 1073784302
Provider Name (Legal Business Name): FAMILY MEDICAL CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9582 PRINCETON GLENDALE RD
HAMILTON OH
45011-9709
US

IV. Provider business mailing address

9582 PRINCETON GLENDALE RD
HAMILTON OH
45011-9709
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-5640
  • Fax: 513-346-5644
Mailing address:
  • Phone: 513-346-5640
  • Fax: 513-346-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35055812
License Number StateOH

VIII. Authorized Official

Name: DR. JAMES THOMAS BROCKMAN
Title or Position: MANAGING MEMBER/PHYSICIAN
Credential: M.D.
Phone: 513-346-5640