MEDICARE: FAMILY MEDICAL CARE OF RIVERVIEW PA

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		FL

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	:	1922192574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL CARE OF RIVERVIEW PA

Provider Business Mailing Address
First Line	:	7229 US HIGHWAY 301 S
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-4346
Country	:	US
Telephone Number	:	813-677-8418
Fax Number	:	813-677-8419

Provider Business Practice Location Address
First Line	:	7229 US HIGHWAY 301 S
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-4346
Country	:	US
Telephone Number	:	813-677-8418
Fax Number	:	813-677-8419

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	EDDIE G. LOUDERBACK
Credential	:	C.M.M.
Telephone Number	:	813-677-8418

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	01/05/2010

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