Provider Demographics
NPI:1457399396
Name:THE FAMILY HEALTHCARE CENTER
Entity Type:Organization
Organization Name:THE FAMILY HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ENOCH
Authorized Official - Middle Name:G
Authorized Official - Last Name:ULMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-833-5986
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-0030
Mailing Address - Country:US
Mailing Address - Phone:864-833-5986
Mailing Address - Fax:864-833-3987
Practice Address - Street 1:23013 HIGHWAY 76 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7530
Practice Address - Country:US
Practice Address - Phone:864-833-5986
Practice Address - Fax:864-833-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0644Medicaid
SC4280Medicare ID - Type Unspecified