Provider Demographics
NPI:1215322557
Name:CARTHAGE FAMILY CARE PA
Entity type:Organization
Organization Name:CARTHAGE FAMILY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:910-947-3521
Mailing Address - Street 1:1001 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-5008
Mailing Address - Country:US
Mailing Address - Phone:910-947-3521
Mailing Address - Fax:
Practice Address - Street 1:1001 MONROE ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NC
Practice Address - Zip Code:28327-5008
Practice Address - Country:US
Practice Address - Phone:910-947-3521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200816261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1558365403OtherPROVIDER NPI