Healthcare Provider Details

I. General information

NPI: 1346425659
Provider Name (Legal Business Name): THE FAMILY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 FLORIDA AVE
LYNN HAVEN FL
32444-1737
US

IV. Provider business mailing address

621 FLORIDA AVE
LYNN HAVEN FL
32444-1737
US

V. Phone/Fax

Practice location:
  • Phone: 850-265-3606
  • Fax: 850-271-0400
Mailing address:
  • Phone: 850-265-3606
  • Fax: 850-271-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS7653
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS10197
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS10001
License Number StateFL

VIII. Authorized Official

Name: DR. KYMBERLY DEE RITTMAN
Title or Position: PARTNER
Credential: D.O.
Phone: 850-265-3606