Healthcare Provider Details

I. General information

NPI: 1245561455
Provider Name (Legal Business Name): JEFFERSON FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SOUTH ST
PHILADELPHIA PA
19147-2305
US

IV. Provider business mailing address

211 SOUTH ST
PHILADELPHIA PA
19147-2305
US

V. Phone/Fax

Practice location:
  • Phone: 214-345-6789
  • Fax:
Mailing address:
  • Phone: 214-345-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA DIANE HOWARD
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 214-345-6789