Provider Demographics
NPI:1316371636
Name:FAMILY MEDICAL CENTRE
Entity type:Organization
Organization Name:FAMILY MEDICAL CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-558-3571
Mailing Address - Street 1:3410 W 84TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4906
Mailing Address - Country:US
Mailing Address - Phone:305-558-3571
Mailing Address - Fax:
Practice Address - Street 1:3470 NW 82ND AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1024
Practice Address - Country:US
Practice Address - Phone:305-398-1991
Practice Address - Fax:305-398-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0019774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0584Medicare PIN