| Family Care Center, Llc | |
|
4300 W Cypress St Ste 825 Tampa FL 33607-4253 | |
| (719) 540-2100 | |
| Not Available |
| Full Name | Family Care Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4300 W Cypress St Ste 825, Tampa, Florida |
| Authorized Official Name and Position | Christian M Ellis (PROVIDER ENGAGEMENT & CREDENTIALING) |
| Authorized Official Contact | 7655402100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Care Center, Llc 2860 S Circle Dr Ste 109 Colorado Springs CO 80906-4195 Ph: (719) 540-2100 | Family Care Center, Llc 4300 W Cypress St Ste 825 Tampa FL 33607-4253 Ph: (719) 540-2100 |
| NPI Number | 1689441255 |
|---|---|
| Provider Enumeration Date | 12/05/2023 |
| Last Update Date | 12/05/2023 |
| Certification Date | 12/05/2023 |
| Medicare PECOS PAC ID | 5991064420 |
|---|---|
| Medicare Enrollment ID | O20240422001047 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689441255 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Minh-chau T Dang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649943911 PECOS PAC ID: 8022414937 Enrollment ID: I20210901000711 |
| Provider Name | Samuel O Battle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013635150 PECOS PAC ID: 9436527835 Enrollment ID: I20221116000120 |
| Provider Name | Charles Lee Weber |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841277258 PECOS PAC ID: 1254600935 Enrollment ID: I20240422000962 |
| Provider Name | Alexander Morris Kaplan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134500614 PECOS PAC ID: 9739549924 Enrollment ID: I20240515001920 |
| Provider Name | Aaron Avallone |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366646069 PECOS PAC ID: 0840553087 Enrollment ID: I20240516000879 |
| Provider Name | Ginelle Moore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730569534 PECOS PAC ID: 4880136571 Enrollment ID: I20240610002472 |
| Provider Name | Holly Mckinnon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669007910 PECOS PAC ID: 7517400047 Enrollment ID: I20240625001116 |
| Provider Name | Christopher Ivany |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649260209 PECOS PAC ID: 4880089564 Enrollment ID: I20241210004765 |
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