Provider Demographics
NPI:1043633266
Name:FAMILY MEDICAL CENTER OF PORT RICHEY IN
Entity type:Organization
Organization Name:FAMILY MEDICAL CENTER OF PORT RICHEY IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-861-7043
Mailing Address - Street 1:10806 US HIGHWAY 19 STE 102A
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-2582
Mailing Address - Country:US
Mailing Address - Phone:727-861-7043
Mailing Address - Fax:727-861-7382
Practice Address - Street 1:10806 US HIGHWAY 19 STE 102A
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-2582
Practice Address - Country:US
Practice Address - Phone:727-861-7043
Practice Address - Fax:727-861-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty