=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588085872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY MEDICARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2014
-----------------------------------------------------
Last Update Date | 01/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2133 PELHAM DR
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-2725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-296-9537
-----------------------------------------------------
Fax | 540-427-6579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2133 PELHAM DR
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-2725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-296-9537
-----------------------------------------------------
Fax | 540-427-6579
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTQ
-----------------------------------------------------
Name | UZMA M ALI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 540-296-9537
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0101238234
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------