Provider Demographics
NPI:1063758779
Name:CENTER FOR FAMILY MEDICINE MDPC
Entity type:Organization
Organization Name:CENTER FOR FAMILY MEDICINE MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:FOSDICK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:520-426-1400
Mailing Address - Street 1:301 E COTTONWOOD LN STE 2
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2551
Mailing Address - Country:US
Mailing Address - Phone:520-426-1400
Mailing Address - Fax:520-426-1268
Practice Address - Street 1:301 E COTTONWOOD LN STE 2
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2551
Practice Address - Country:US
Practice Address - Phone:520-426-1400
Practice Address - Fax:520-426-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13210261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center