Organization Name: | FRANKLIN C. FETTER FAMILY HEALTH CENTER, INC |
NPI Number: | 1518246966 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RONALD A RAVENELL (CEO) |
Mailing Address: | 3429 Camp Care Rd Johns Island |
State: | SC US |
Postal Code: | 294557131 |
Phone Number: | 8437681720 |
Fax Number: | |
NPI Enumeration Date: | 08/16/2011 |
NPI Last Update Date: | 09/01/2011 |
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: |