Organization Name: | C&J FAMILY HEALTH CARE CLINIC, LLC |
NPI Number: | 1467563114 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FRANCES CLARK (OWNER) |
Mailing Address: | 11920 W State Road 10 Demotte |
State: | IN US |
Postal Code: | 463109755 |
Phone Number: | 2193455151 |
Fax Number: | 2193455252 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 71000776A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |