Organization
FAMILY MEDICINE SPECIALISTS, S.C.
Active
Other names
Family Medicine Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
JASMINE WORTHEN (CREDENTIALING SPECIALIST)
(727) 755-0693
Entity
Organization
Contact information
Practice address
431 W LIBERTY STREET, WAUCONDA, IL 60084
(847) 508-5897
(847) 526-2017
Mailing address
311 PARK PLACE BLVD, 5TH FLOOR, CLEARWATER, FL 33759-4904
(727) 755-0693
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036083207
—
IL
Enumeration date
11/25/2015
Last updated
11/25/2015
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