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General NPI Number Information
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NPI Number | 1194825588
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Entity Type | Organization
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Legal Business Name | ADVANTAGE FAMILY MEDICAL CARE INC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 5006 STATE ROAD 54
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-5908
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Country | US
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Telephone | 727-569-7777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1547
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City | TARPON SPRINGS
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State | FL
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Zip | 34688-1547
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Country | US
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Telephone | 727-569-7777
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDEN
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Name | DR. ANDREW ALEXANDER FETCHIK
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Credential | D.O.
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Telephone | 727-569-7777
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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 | OS6553
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License Number State | FL
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