Full Name | |
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Speciality | Clinic/Center |
Location | 80 W Main St, Butler, Georgia |
Authorized Official Name and Position | Linda Young (SECRETARY) |
Authorized Official Contact | 2292738881 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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80 W Main St Butler GA 31006-5156 Ph: (478) 862-5453 | 80 W Main St Butler GA 31006-5156 Ph: (478) 862-5453 |
NPI Number | 1104255934 |
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Provider Enumeration Date | 11/02/2013 |
Last Update Date | 01/03/2020 |
Medicare PECOS PAC ID | 7810980794 |
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Medicare Enrollment ID | O20140225000925 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104255934 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Decker Family Practice Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 18 S Broad St, Butler, GA 31006 Phone: 478-837-7121 Fax: 478-837-7020 | |