=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225252232
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMESTEAD FAMILY MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 08/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 N KROME AVE
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-4408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-243-4100
-----------------------------------------------------
Fax | 786-243-4111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 909 N KROME AVE
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-4408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-243-4100
-----------------------------------------------------
Fax | 786-243-4111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. SONIA TALARICO
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 786-243-4100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 0S9473
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------