MEDICARE: SALAZAR FAMILY HEALTH CARE, INC

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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH9637	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2524166	OTHER	FL	AETNA
3	45760	OTHER	FL	BLUE SHIELD FL

General Provider Information

NPI Number	:	1437141686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALAZAR FAMILY HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	PO BOX 1312
Second Line	:
City	:	MULBERRY
State	:	FL
Zip	:	33860-1312
Country	:	US
Telephone Number	:	863-604-2235
Fax Number	:	863-646-8575

Provider Business Practice Location Address
First Line	:	708 N CHURCH AVE
Second Line	:
City	:	MULBERRY
State	:	FL
Zip	:	33860-2034
Country	:	US
Telephone Number	:	863-425-9309
Fax Number	:	863-425-8401

Authorized Official
Title or Position	:	OWNER - PRESIDENT
Name	:	MRS. PATRICIA G SALAZAR
Credential	:
Telephone Number	:	863-604-2235

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	10/25/2011

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