Provider Demographics
NPI:1386680932
Name:FAMILY HEALTH CARE OF DELRAY, INC.
Entity type:Organization
Organization Name:FAMILY HEALTH CARE OF DELRAY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:LEFEVRE
Authorized Official - Last Name:ALEXANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-276-8444
Mailing Address - Street 1:1483 S. CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445
Mailing Address - Country:US
Mailing Address - Phone:561-276-8444
Mailing Address - Fax:561-276-8805
Practice Address - Street 1:1483 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6378
Practice Address - Country:US
Practice Address - Phone:561-276-8594
Practice Address - Fax:561-276-8805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379073800Medicaid
FLF91314Medicare UPIN
FLQ0211Medicare ID - Type UnspecifiedPROVIDER NUMBER