| NPI | 1255369427 |
|---|---|
| Other Name | FAMILY HEALTHCARE CLINIC |
| Entity Type | Organization |
| Authorized Contact | RIKKI BONTHRON CFO 618-439-3161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036085111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209005496) |
| 207R00000X Internal Medicine | |
| 363A00000X Physician Assistant (Licence: IL 085002236) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2019-02-25 |