Provider Demographics
NPI:1871208074
Name:FAMILIA FIRST HEALTH NFP
Entity type:Organization
Organization Name:FAMILIA FIRST HEALTH NFP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:217-637-1310
Mailing Address - Street 1:PO BOX 2403
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61825
Mailing Address - Country:US
Mailing Address - Phone:772-559-5878
Mailing Address - Fax:
Practice Address - Street 1:1401 S STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820
Practice Address - Country:US
Practice Address - Phone:217-721-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty