Provider Demographics
NPI:1851636070
Name:BOSTON FAMILY CARE CLINIC, LLC
Entity Type:Organization
Organization Name:BOSTON FAMILY CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-200-4019
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-1276
Mailing Address - Country:US
Mailing Address - Phone:229-236-0861
Mailing Address - Fax:229-236-0871
Practice Address - Street 1:118 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:GA
Practice Address - Zip Code:31626-2257
Practice Address - Country:US
Practice Address - Phone:229-236-0861
Practice Address - Fax:229-236-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care