Provider Demographics
NPI:1235121880
Name:RICHMOND FAMILY CARE CENTER, P.C.
Entity Type:Organization
Organization Name:RICHMOND FAMILY CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:765-966-5949
Mailing Address - Street 1:795 SIM HODGIN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1928
Mailing Address - Country:US
Mailing Address - Phone:765-966-5949
Mailing Address - Fax:765-962-6268
Practice Address - Street 1:795 SIM HODGIN PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1928
Practice Address - Country:US
Practice Address - Phone:765-966-5949
Practice Address - Fax:765-962-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100257240AMedicaid
IN100257240AMedicaid