Basic Information
| Provider Information | |||||||||
| NPI: | 1902975881 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY PRACTICE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1314 E 7TH ST | ||||||||
| Address2: | #101 | ||||||||
| City: | AUBURN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467062535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2609250403 | ||||||||
| FaxNumber: | 2609259545 | ||||||||
| Practice Location | |||||||||
| Address1: | 1314 E 7TH ST | ||||||||
| Address2: | #101 | ||||||||
| City: | AUBURN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467062535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2609250403 | ||||||||
| FaxNumber: | 2609259545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHASE | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2609250403 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01034432 | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.