Provider Demographics
NPI:1871789362
Name:FAMILY HEALTH CLINIC LLC
Entity type:Organization
Organization Name:FAMILY HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN CNS
Authorized Official - Phone:406-727-3242
Mailing Address - Street 1:PO BOX 1567
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-1567
Mailing Address - Country:US
Mailing Address - Phone:406-727-3242
Mailing Address - Fax:406-727-3161
Practice Address - Street 1:900 6TH ST SW
Practice Address - Street 2:SUITE 2
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-3207
Practice Address - Country:US
Practice Address - Phone:406-727-3242
Practice Address - Fax:406-727-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care