Provider Demographics
NPI:1366607335
Name:FAMILY CARE OF PALM COAST PA
Entity type:Organization
Organization Name:FAMILY CARE OF PALM COAST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RABKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-445-2003
Mailing Address - Street 1:4869 PALM COAST PKWY NW # 802
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3661
Mailing Address - Country:US
Mailing Address - Phone:386-445-2003
Mailing Address - Fax:386-445-7445
Practice Address - Street 1:4869 PALM COAST PARKWAY NW 802
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32145
Practice Address - Country:US
Practice Address - Phone:386-445-2003
Practice Address - Fax:386-445-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL92879261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6363ZOtherMEDICARE NUMBER
FL273940200Medicaid