Provider Demographics
| NPI: | 1598580938 |
|---|---|
| Name: | FAMILY HEALTHCARE MEDICAL GROUP INC |
| Entity type: | Organization |
| Organization Name: | FAMILY HEALTHCARE MEDICAL GROUP INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | ALFREDO |
| Authorized Official - Middle Name: | J |
| Authorized Official - Last Name: | GOTERA AVILA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | SA |
| Authorized Official - Phone: | 407-820-2693 |
| Mailing Address - Street 1: | 600 NW 35TH AVE STE 102 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MIAMI |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33125-4000 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 407-820-2693 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 600 NW 35TH AVE STE 102 |
| Practice Address - Street 2: | |
| Practice Address - City: | MIAMI |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33125-4000 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 407-820-2693 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-11-20 |
| Last Update Date: | 2024-11-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 251E00000X | Agencies | Home Health | ||
| No | 261QI0500X | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | ||
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |
