Organization
FAMILY MEDICINE SPECIALISTS, S.C.
Active
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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