Provider Demographics
NPI:1144470766
Name:FAMILY WELLCARE CLINIC INC
Entity type:Organization
Organization Name:FAMILY WELLCARE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:QUINONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-393-6054
Mailing Address - Street 1:3504B RAINBOW DR
Mailing Address - Street 2:SUITE 165
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-6310
Mailing Address - Country:US
Mailing Address - Phone:256-393-6054
Mailing Address - Fax:
Practice Address - Street 1:3504B RAINBOW DR
Practice Address - Street 2:SUITE 165
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6310
Practice Address - Country:US
Practice Address - Phone:256-393-6054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty