Provider Demographics
NPI:1225348584
Name:PATEL FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:PATEL FAMILY MEDICINE LLC
Other - Org Name:FAMILY MEDICINE CENTER OF PLYMOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-936-3178
Mailing Address - Street 1:PO BOX 18187
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4076
Mailing Address - Country:US
Mailing Address - Phone:574-936-3178
Mailing Address - Fax:574-936-1084
Practice Address - Street 1:105 WATER ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-2148
Practice Address - Country:US
Practice Address - Phone:574-936-3178
Practice Address - Fax:574-936-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063921A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center