| Organization Name: | FAMILY HEALTH CLINIC, INC. |
| NPI Number: | 1972529543 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WARREN S DEWITT (OWNER) |
| Mailing Address: | 619 Broad Ave Susquehanna |
| State: | PA US |
| Postal Code: | 188471615 |
| Phone Number: | 5708533995 |
| Fax Number: | 5708533728 |
| NPI Enumeration Date: | 07/15/2006 |
| NPI Last Update Date: | 06/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | MD024723E |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |