MEDICARE: FAMILY HEALTH MEDICAL

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	261Q00000X	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

General Provider Information

NPI Number	:	1871768606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH MEDICAL

Provider Business Mailing Address
First Line	:	PO BOX 817
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63702-0817
Country	:	US
Telephone Number	:	660-259-2240
Fax Number	:	660-259-2250

Provider Business Practice Location Address
First Line	:	825 S HIGHWAY 13
Second Line	:
City	:	LEXINGTON
State	:	MO
Zip	:	64067-1515
Country	:	US
Telephone Number	:	660-259-2240
Fax Number	:	660-259-2250

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MRS. AMY D LEDBETTER
Credential	:
Telephone Number	:	573-651-4488

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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Directions to “FAMILY HEALTH MEDICAL ” Practice Location

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