| Organization Name: | FOUNTAIN CITY MEDICAL CLINIC INC |
| NPI Number: | 1083886915 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PEDRITO A GALUPO (PRESIDENT) |
| Mailing Address: | 324 W High St Bryan |
| State: | OH US |
| Postal Code: | 435061614 |
| Phone Number: | 4196362525 |
| Fax Number: | 4196360632 |
| NPI Enumeration Date: | 04/01/2008 |
| NPI Last Update Date: | 04/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 35033085 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |