Provider Demographics
NPI:1801104583
Name:FAMILY HEALTH MEDICAL SERVICES JAMESTOWN CONVENIENCE CARE
Entity type:Organization
Organization Name:FAMILY HEALTH MEDICAL SERVICES JAMESTOWN CONVENIENCE CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-753-5315
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:95 E CHAUTAUQUA ST
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-0168
Mailing Address - Country:US
Mailing Address - Phone:716-753-7107
Mailing Address - Fax:716-753-5367
Practice Address - Street 1:320 PRATHER AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6920
Practice Address - Country:US
Practice Address - Phone:716-753-7107
Practice Address - Fax:716-753-5367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH MEDICAL SERVICES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-16
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty