Organization
FIRST FAMILY PRACTICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TOMMY L LOUISVILLE M.D. (MEDICAL DIRECTOR)
(863) 294-6132
Entity
Organization
Contact information
Practice address
320 1ST ST S, SUITE 200, WINTER HAVEN, FL 33880-3501
(863) 294-6132
(863) 293-8450
Mailing address
320 1ST ST S STE 200, SUITE 200, WINTER HAVEN, FL 33880-3501
(863) 294-6132
(863) 293-8450
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01112353
AMERIGROUP
FL
Enumeration date
04/10/2008
Last updated
10/01/2013
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