Provider Demographics
NPI:1447654876
Name:FAMILY CARE CENTER CORP
Entity type:Organization
Organization Name:FAMILY CARE CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOLBERTO
Authorized Official - Middle Name:ARMANDO
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-526-3555
Mailing Address - Street 1:2928 DANIELS ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2912
Mailing Address - Country:US
Mailing Address - Phone:850-526-3555
Mailing Address - Fax:850-526-3570
Practice Address - Street 1:2928 DANIELS ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2912
Practice Address - Country:US
Practice Address - Phone:850-526-3555
Practice Address - Fax:850-526-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110815100Medicaid
FL0093SOtherFLORIDA BLUE