Family Healthcare Clinic & Rehab

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

148973 Issued in IL

Legal business name

FAMILY HEALTHCARE CLINIC & REHAB

Practice address

701 N Commercial St
Suite 4
Harrisburg, IL 62946-3335

Phone

(618) 253-8863

Fax

(618) 253-8864

NPI assigned

Aug 2, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Augustine Ebong

Title

President/Agent

Phone

(618) 253-8863

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jamie Lyn Mabry, APN/CNP

  • Family Nurse Practitioner
  • Herrin, IL
  • NPI 1902812688
  NPD (past)
• Malik Dababneh, DO

  • Family Medicine Physician
  • Dearborn, MI
  • NPI 1306853221
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215944152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 N COMMERCIAL ST",
            "address_2": "SUITE 4",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629463335",
            "telephone_number": "618-253-8863",
            "fax_number": "618-253-8864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N COMMERCIAL ST",
            "address_2": "SUITE 4",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629463335",
            "telephone_number": "618-253-8863",
            "fax_number": "618-253-8864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTHCARE CLINIC & REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EBONG",
        "authorized_official_first_name": "AUGUSTINE",
        "authorized_official_title_or_position": "PRESIDENT/AGENT",
        "authorized_official_telephone_number": "618-253-8863"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "148973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Etienne, RPH
• Eubanks & Daugherty, LLC
• Krystina Lee Eubanks, O.D.
• Matthew Blaine Eubanks, M.D.
• Melodi G Ewing, MD
• Fenton Dialysis LLC
• Ferrell Hospital Community Foundation
• Ferrell Hospital Community Foundation
• Ferrell Hospital Community Foundation
• Clayton T Ford, MD

• All providers in Harrisburg, IL
• Rural Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.