Provider Demographics
NPI:1306806815
Name:PINEHURST FAMILY CARE CENTER,P.A.
Entity type:Organization
Organization Name:PINEHURST FAMILY CARE CENTER,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-215-5555
Mailing Address - Street 1:10 AVIEMORE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9700
Mailing Address - Country:US
Mailing Address - Phone:910-215-5555
Mailing Address - Fax:910-215-6134
Practice Address - Street 1:10 AVIEMORE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9700
Practice Address - Country:US
Practice Address - Phone:910-215-5555
Practice Address - Fax:910-215-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty