Provider Demographics
NPI:1063427508
Name:HALLMARK FAMILY PHYSICIANS, INC.
Entity type:Organization
Organization Name:HALLMARK FAMILY PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/ CFO/CCO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:828-757-5221
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-0710
Mailing Address - Country:US
Mailing Address - Phone:828-757-5070
Mailing Address - Fax:828-757-7882
Practice Address - Street 1:1766 CONNELLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-7827
Practice Address - Country:US
Practice Address - Phone:828-728-8224
Practice Address - Fax:828-728-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900082Medicaid
NC016XJOtherBCBS
NC2345383Medicare ID - Type Unspecified