Provider Demographics
NPI:1285778829
Name:TARHEEL FAMILY MEDICINE PA
Entity type:Organization
Organization Name:TARHEEL FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVA
Authorized Official - Middle Name:RICHARDSON
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-582-2696
Mailing Address - Street 1:224 W MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-3322
Mailing Address - Country:US
Mailing Address - Phone:910-582-2696
Mailing Address - Fax:910-582-2640
Practice Address - Street 1:224 W MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-3322
Practice Address - Country:US
Practice Address - Phone:910-582-2696
Practice Address - Fax:910-582-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2185224JMedicare PIN
NCDF4199Medicare PIN