| Enterprise Family Healthcare | |
|
2192 Ingleside Ave Macon GA 31204-2030 | |
| (478) 745-9880 | |
| (478) 745-8611 |
| Full Name | Enterprise Family Healthcare |
|---|---|
| Speciality | Clinic/Center |
| Location | 2192 Ingleside Ave, Macon, Georgia |
| Authorized Official Name and Position | Dana M Harrelson (OFFICE MANAGER) |
| Authorized Official Contact | 4787459559 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Enterprise Family Healthcare 2192 Ingleside Ave Macon GA 31204-2030 Ph: (478) 745-9880 | Enterprise Family Healthcare 2192 Ingleside Ave Macon GA 31204-2030 Ph: (478) 745-9880 |
| NPI Number | 1760668586 |
|---|---|
| Provider Enumeration Date | 01/10/2008 |
| Last Update Date | 01/10/2008 |
| Medicare PECOS PAC ID | 3476598194 |
|---|---|
| Medicare Enrollment ID | O20050623000163 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760668586 | NPI | - | NPPES |
| GRP4689 | Other | GA | MEDICARE GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 040767 (Georgia) | Primary |
| Provider Name | Darl W Rantz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215911102 PECOS PAC ID: 5496914939 Enrollment ID: I20120302000188 |
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