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NPI Code Detail

MEDICARE: SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC.

MEDICARE: SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104940493
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC.
Provider Business Mailing Address
First Line : 1 EXECUTIVE DRIVE 701A
Second Line : SUITE 400
City : MARLTON
State : NJ
Zip : 08053-4144
Country : US
Telephone Number : 609-567-0434
Fax Number : 609-704-5615
Provider Business Practice Location Address
First Line : 238 E BROADWAY
Second Line :
City : SALEM
State : NJ
Zip : 08079-1108
Country : US
Telephone Number : 856-935-7711
Fax Number : 856-935-9123
Authorized Official
Title or Position : PRESIDENT CEO
Name : LINDA FLAKE
Credential :
Telephone Number : 609-567-0434
Provider Enumeration Date : 03/19/2007
Last Update Date : 09/01/2022

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Directions to “SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC. ” Practice Location

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