Provider Demographics
NPI:1215325279
Name:AHOSKIE ADULT MEDICINE CLINIC, PLLC
Entity type:Organization
Organization Name:AHOSKIE ADULT MEDICINE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-967-9932
Mailing Address - Street 1:233 SOUTH ST W
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3335
Mailing Address - Country:US
Mailing Address - Phone:125-233-2333
Mailing Address - Fax:252-332-3350
Practice Address - Street 1:233 SOUTH ST W
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3335
Practice Address - Country:US
Practice Address - Phone:125-233-2333
Practice Address - Fax:252-332-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20100261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care