Organization Name: | FETTER HEALTH CARE NETWORK INC |
NPI Number: | 1003827304 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | REUBEN J PETTIFORD (CEO) |
Mailing Address: | 51 Nassau St Charleston |
State: | SC US |
Postal Code: | 294035513 |
Phone Number: | 8437224112 |
Fax Number: | 8435778960 |
NPI Enumeration Date: | 08/11/2006 |
NPI Last Update Date: | 08/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |