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General NPI Number Information
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NPI Number | 1659312072
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE MEDICAL CENTER LTD
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 511 W FAIRCHILD ST
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City | DANVILLE
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State | IL
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Zip | 61832-3801
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Country | US
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Telephone | 217-431-2025
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Fax | 217-431-0014
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Provider Business Mailing Address
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Address Line | 511 W FAIRCHILD ST
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City | DANVILLE
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State | IL
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Zip | 61832-3801
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Country | US
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Telephone | 217-431-2025
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Fax | 217-431-0014
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE R GINDI
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Credential | MD
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Telephone | 217-431-2025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 036100736
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 036087566
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License Number State | IL
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