# FAMILY MEDICAL CARE OF PALM COAST LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vicencio Antonio III
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912177577
- **Authorized official:** DR. ANTONIO SISON VICENCIO III MD (SOLE PROPRIETOR)
- **Authorized official phone:** (386) 586-3466

## Contact information

- **Practice address:** 21 HOSPITAL DR, SUITE 230, PALM COAST, FL 32164-2452
- **Practice address phone:** (386) 586-3466
- **Practice address fax:** (386) 586-3467
- **Mailing address:** PO BOX 354339, PALM COAST, FL 32135-4339
- **Mailing address phone:** (386) 586-3466
- **Mailing address fax:** (386) 586-3467

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/10/2008
- **Last updated:** 09/10/2008