Provider Demographics
NPI:1326322736
Name:FAMILY PRACTICE MEDICAL CENTER
Entity Type:Organization
Organization Name:FAMILY PRACTICE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RIAD
Authorized Official - Last Name:GINDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-431-2025
Mailing Address - Street 1:511 W. FAIRCHILD STREET
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832
Mailing Address - Country:US
Mailing Address - Phone:217-431-2025
Mailing Address - Fax:217-431-0014
Practice Address - Street 1:511 W. FAIRCHILD STREET
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-431-2025
Practice Address - Fax:217-431-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty