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General NPI Number Information
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NPI Number | 1336511286
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CENTER OF PORT RICHEY
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 5225 ENCLAVE DRIVE
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City | OLDSMAR
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State | FL
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Zip | 34677
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Country | US
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Telephone | 727-375-5885
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Fax | 727-375-5841
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Provider Business Mailing Address
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Address Line | 5225 ENCLAVE DR
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City | OLDSMAR
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State | FL
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Zip | 34677-1962
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Country | US
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Telephone | 727-375-5885
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Fax | 727-375-5841
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Authorized Official
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Title or Position | OWNER
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Name | ADAM GREENFIELD
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Credential | D.O.
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Telephone | 727-375-5885
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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 | ME91998
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License Number State | FL
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