Provider Demographics
NPI:1194940684
Name:FMCM, INCORPORATED
Entity type:Organization
Organization Name:FMCM, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAUCHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-348-0990
Mailing Address - Street 1:2551 BOGGY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3806
Mailing Address - Country:US
Mailing Address - Phone:407-348-0990
Mailing Address - Fax:407-944-9041
Practice Address - Street 1:2551 BOGGY CREEK RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3806
Practice Address - Country:US
Practice Address - Phone:407-348-0990
Practice Address - Fax:407-944-9041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care