Provider Demographics
NPI:1528648375
Name:FAMILY CLINIC MANCHASTER LLC
Entity type:Organization
Organization Name:FAMILY CLINIC MANCHASTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-259-7334
Mailing Address - Street 1:415 RICHMOND RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-1212
Mailing Address - Country:US
Mailing Address - Phone:606-598-8831
Mailing Address - Fax:
Practice Address - Street 1:415 RICHMOND RD UNIT B
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-1212
Practice Address - Country:US
Practice Address - Phone:606-598-8831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100953240Medicaid