NPIMap

Organization Active NPI

Familycare Medical Group PC

  • Non-Pharmacy Dispensing Site
  • Camillus, NY
National Provider Identifier
1508277492
Registry record updated May 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
155562 Issued in NY
Legal business name
FAMILYCARE MEDICAL GROUP PC
Doing business as
FCMG Camillus
Practice address
436 Hinsdale Rd
Camillus, NY 13031-1648
Phone
(315) 488-0996
NPI assigned
May 13, 2014
Organization subpart
Yes
Parent organization
MEDVANTXAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 964-1506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 155562 NY Primary

Addresses

Primary practice location

436 Hinsdale Rd
Camillus, NY 13031-1648

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • FCMG Camillus Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Familycare Medical Grou6 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1508277492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 HINSDALE RD",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130311648",
            "telephone_number": "315-488-0996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILYCARE MEDICAL GROUP PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX",
        "enumeration_date": "2014-05-13",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NY",
            "license": "155562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FCMG Camillus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Camillus, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.