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General NPI Number Information
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NPI Number | 1043633266
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CENTER OF PORT RICHEY IN
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 10806 US HIGHWAY 19 STE 102A
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City | PORT RICHEY
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State | FL
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Zip | 34668-2582
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Country | US
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Telephone | 727-861-7043
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Fax | 727-861-7382
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Provider Business Mailing Address
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Address Line | 10806 US HIGHWAY 19 STE 102A
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City | PORT RICHEY
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State | FL
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Zip | 34668-2582
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Country | US
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Telephone | 727-861-7043
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Fax | 727-861-7382
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADAM GREENFIELD
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Credential |
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Telephone | 727-861-7043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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