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General NPI Number Information
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NPI Number | 1841549599
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Entity Type | Organization
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Legal Business Name | CENTRAL FAMILY CARE LLC
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 105 E JEFFERSON ST
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City | QUINCY
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State | FL
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Zip | 32351-2407
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Country | US
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Telephone | 850-566-9014
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Fax | 281-220-8979
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Provider Business Mailing Address
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Address Line | 362B LORI LN
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City | CARRABELLE
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State | FL
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Zip | 32322-3252
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Country | US
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Telephone | 850-566-9014
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Fax | 281-220-8979
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Authorized Official
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Title or Position | PRESIDENT
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Name | SIMEON H VILCHEZ
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Credential | M.D.
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Telephone | 850-566-9014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN 379
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License Number State | FL
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