MEDICARE: FAMILY MEDICINE CONSULTANTS CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	281P00000X	Chronic Disease Hospital	71002672A	IN
2	314000000X	Skilled Nursing Facility	71002672A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215180096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE CONSULTANTS CORP.

Provider Business Mailing Address
First Line	:	650 GRANT ST STE 5
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46404-1551
Country	:	US
Telephone Number	:	219-882-7730
Fax Number	:	219-882-1605

Provider Business Practice Location Address
First Line	:	650 GRANT ST STE 5
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46404-1551
Country	:	US
Telephone Number	:	219-882-7730
Fax Number	:	219-882-1605

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MRS. DEBRA DENISE GIVENS
Credential	:	NURSE PRACTITIONER
Telephone Number	:	219-882-7730

Provider Enumeration Date	:	10/24/2008
Last Update Date	:	10/24/2008

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Directions to “FAMILY MEDICINE CONSULTANTS CORP. ” Practice Location

Language	Start Address	Practice Location

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