MEDICARE: FAMILY CARE CLINIC, PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780073932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE CLINIC, PC

Provider Business Mailing Address
First Line	:	817 LINCOLN AVE
Second Line	:
City	:	HARVEY
State	:	ND
Zip	:	58341-1521
Country	:	US
Telephone Number	:	701-324-2171
Fax Number	:	701-324-2173

Provider Business Practice Location Address
First Line	:	817 LINCOLN AVE
Second Line	:
City	:	HARVEY
State	:	ND
Zip	:	58341-1521
Country	:	US
Telephone Number	:	701-324-2171
Fax Number	:	701-324-2173

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	MRS. LISA M NEUMILLER
Credential	:	FNP
Telephone Number	:	701-324-2171

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	01/07/2016

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