Provider Demographics
NPI:1548452600
Name:EVANS FAMILY CARE PA
Entity type:Organization
Organization Name:EVANS FAMILY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOC
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-532-4615
Mailing Address - Street 1:5026 SILVER STAR RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-4545
Mailing Address - Country:US
Mailing Address - Phone:407-532-4615
Mailing Address - Fax:407-532-4686
Practice Address - Street 1:5026 SILVER STAR RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-4545
Practice Address - Country:US
Practice Address - Phone:407-532-4615
Practice Address - Fax:407-532-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center