Healthcare Provider Details

I. General information

NPI: 1437290798
Provider Name (Legal Business Name): FAMILY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S. CHURCH ST.
LOUISVILLE IL
62858
US

IV. Provider business mailing address

134 S. CHURCH ST.
LOUISVILLE IL
62858
US

V. Phone/Fax

Practice location:
  • Phone: 618-665-4612
  • Fax: 618-665-4610
Mailing address:
  • Phone: 618-665-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BERNITA BELL
Title or Position: OWNER
Credential: A.P.N.
Phone: 618-665-4612