Provider Demographics
NPI:1437341278
Name:FAMILY HEALTHCARE CLINIC, APMC
Entity Type:Organization
Organization Name:FAMILY HEALTHCARE CLINIC, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-394-7111
Mailing Address - Street 1:1117 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-3513
Mailing Address - Country:US
Mailing Address - Phone:337-394-7111
Mailing Address - Fax:337-394-8105
Practice Address - Street 1:1117 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-3513
Practice Address - Country:US
Practice Address - Phone:337-394-7111
Practice Address - Fax:337-394-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023274261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care