Organization
FAMILY MEDICAL GROUP PA
Active
Parent organization
FAMILY MEDICAL GROUP PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAMILY MEDICAL GROUP PA
Authorized official
JOANNE E STAYTON (PRACTICE ADMINISTRATOR)
(863) 465-7010
Entity
Organization
Contact information
Practice address
113 HEALTH WAY, LAKE PLACID, FL 33852-8123
(863) 465-7010
Mailing address
113 HEALTH WAY, LAKE PLACID, FL 33852-8123
(863) 465-7010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45269
BCBSFL
FL
05
—
660046800
—
FL
05
—
660129400
—
FL
05
—
660219300
—
FL
Enumeration date
12/15/2006
Last updated
05/24/2021
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