Provider Demographics
NPI:1962893974
Name:FAMILY IMMEDIATE CARE,LLC
Entity type:Organization
Organization Name:FAMILY IMMEDIATE CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHETPAILIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARALIKIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-218-5788
Mailing Address - Street 1:9429 WINTERSET DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2845
Mailing Address - Country:US
Mailing Address - Phone:571-218-5788
Mailing Address - Fax:
Practice Address - Street 1:420 ELDEN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4511
Practice Address - Country:US
Practice Address - Phone:571-218-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty