Basic Information
| Provider Information | |||||||||
| NPI: | 1386680932 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY HEALTH CARE OF DELRAY, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | D/B/A FAMILY HEALTH CARE SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1483 S. CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612768444 | ||||||||
| FaxNumber: | 5612768805 | ||||||||
| Practice Location | |||||||||
| Address1: | 1483 S CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334456378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612768594 | ||||||||
| FaxNumber: | 5612768805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 03/14/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ALEXANDRE | ||||||||
| AuthorizedOfficialFirstName: | SERGE | ||||||||
| AuthorizedOfficialMiddleName: | LEFEVRE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 5612768444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FAMILY HEALTH CARE SERVICES, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME69471 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 379073800 | 05 | FL | MEDICAID |