Basic Information
| Provider Information | |||||||||
| NPI: | 1619257961 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY INTERNAL MEDICINE OF OCALA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1623 SW 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344716528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527329844 | ||||||||
| FaxNumber: | 3523514305 | ||||||||
| Practice Location | |||||||||
| Address1: | 1623 SW 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344716528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527329844 | ||||||||
| FaxNumber: | 3523514305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2011 | ||||||||
| LastUpdateDate: | 05/05/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | REDDY | ||||||||
| AuthorizedOfficialFirstName: | KUCHAKULLA | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 3527329844 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.