Provider Demographics
NPI:1992959027
Name:METROWEST FAMILY MEDICINE, INC.
Entity type:Organization
Organization Name:METROWEST FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUREE
Authorized Official - Middle Name:
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-830-1975
Mailing Address - Street 1:320 W SABAL PALM PL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3639
Mailing Address - Country:US
Mailing Address - Phone:407-830-1975
Mailing Address - Fax:407-830-1116
Practice Address - Street 1:1603 S HIAWASSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6438
Practice Address - Country:US
Practice Address - Phone:407-299-0991
Practice Address - Fax:407-298-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBUS-0018500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty