Healthcare Provider Details

I. General information

NPI: 1891764312
Provider Name (Legal Business Name): FAMILY HEALTH CARE PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W BUTLER ST
MERCER PA
16137-1031
US

IV. Provider business mailing address

400 W BUTLER ST PO BOX 578
MERCER PA
16137-1031
US

V. Phone/Fax

Practice location:
  • Phone: 724-662-3943
  • Fax: 724-662-5054
Mailing address:
  • Phone: 724-662-3943
  • Fax: 724-662-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001530870
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: LINDA L. KEIL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 724-662-3943