# ADVANCED FAMILY MEDICINE CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184805830
- **Authorized official:** KATE R LOPS M.D. (OWNER/PHYSICIAN)
- **Authorized official phone:** (850) 423-0761

## Contact information

- **Practice address:** 327 MEDCREST DRIVE, UNIT A, CRESTVIEW, FL 32536
- **Practice address phone:** (850) 423-0761
- **Practice address fax:** (855) 793-3568
- **Mailing address:** 327 MEDCREST DRIVE, UNIT A, CRESTVIEW, FL 32536
- **Mailing address phone:** (850) 423-0761
- **Mailing address fax:** (855) 793-3568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | ME89643 | FL | Yes |

## Other

- **Enumeration date:** 11/23/2007
- **Last updated:** 04/17/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1184803830 | AETNA | FL |
| 01 | — | 1184805830 | HUMANA | FL |
| 01 | — | 37798 | BLUE CROSS BLUE SHIELD | FL |