=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457178691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY MEDICAL COMMUNITY CENTER, 'INC'
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2024
-----------------------------------------------------
Last Update Date | 09/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3215 S US HIGHWAY 1 STE B
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34982-6379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-241-5031
-----------------------------------------------------
Fax | 800-920-8929
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3215 S US HIGHWAY 1 STE B
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34982-6379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-241-5031
-----------------------------------------------------
Fax | 800-920-8929
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARJORIE MERCIE GEDEON
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 772-241-5031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------