Provider Demographics
NPI:1578687851
Name:SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC
Entity Type:Organization
Organization Name:SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-567-0434
Mailing Address - Street 1:1 EXECUTIVE DRIVE 701A
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4144
Mailing Address - Country:US
Mailing Address - Phone:609-567-0434
Mailing Address - Fax:609-704-5615
Practice Address - Street 1:932 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3646
Practice Address - Country:US
Practice Address - Phone:609-383-0880
Practice Address - Fax:609-383-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0031755Medicaid
NJ0031755Medicaid
038156OtherEMPIRE MEDICARE