Provider Demographics
NPI:1891027843
Name:CROOKSVILLE FAMILY CLINIC
Entity Type:Organization
Organization Name:CROOKSVILLE FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:740-982-6872
Mailing Address - Street 1:712 CHINA ST
Mailing Address - Street 2:P.O. BOX 159
Mailing Address - City:CROOKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43731-1124
Mailing Address - Country:US
Mailing Address - Phone:740-982-6872
Mailing Address - Fax:740-982-5551
Practice Address - Street 1:712 CHINA ST
Practice Address - Street 2:
Practice Address - City:CROOKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43731-1124
Practice Address - Country:US
Practice Address - Phone:740-982-6872
Practice Address - Fax:740-982-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care