MEDICARE: FAMILY HEALTHCARE CLINIC, APMC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	023274	LA

General Provider Information

NPI Number	:	1437341278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTHCARE CLINIC, APMC

Provider Business Mailing Address
First Line	:	1117 N MAIN ST STE B
Second Line	:
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-3513
Country	:	US
Telephone Number	:	337-394-7111
Fax Number	:	337-394-8105

Provider Business Practice Location Address
First Line	:	1117 N MAIN ST STE B
Second Line	:
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-3513
Country	:	US
Telephone Number	:	337-394-7111
Fax Number	:	337-394-8105

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL WILTZ
Credential	:	M.D.
Telephone Number	:	337-394-7111

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	08/15/2007

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