Provider Demographics
NPI:1841549599
Name:CENTRAL FAMILY CARE LLC
Entity type:Organization
Organization Name:CENTRAL FAMILY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:H
Authorized Official - Last Name:VILCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-566-9014
Mailing Address - Street 1:362B LORI LN
Mailing Address - Street 2:
Mailing Address - City:CARRABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:32322-3252
Mailing Address - Country:US
Mailing Address - Phone:850-566-9014
Mailing Address - Fax:281-220-8979
Practice Address - Street 1:105 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2407
Practice Address - Country:US
Practice Address - Phone:850-566-9014
Practice Address - Fax:281-220-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN 379208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty