Provider Demographics
NPI:1437550019
Name:FAMILY HEALTH CENTER OF PLAINFIELD
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER OF PLAINFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:CONAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-461-0129
Mailing Address - Street 1:13550 S ROUTE 30
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-5685
Mailing Address - Country:US
Mailing Address - Phone:815-436-1655
Mailing Address - Fax:815-436-1656
Practice Address - Street 1:13550 S ROUTE 30
Practice Address - Street 2:SUITE 100
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5685
Practice Address - Country:US
Practice Address - Phone:815-436-1655
Practice Address - Fax:815-436-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier