Provider Demographics
NPI:1386713402
Name:CAROLINA FAMILY PRACTICE CENTRE, PA
Entity type:Organization
Organization Name:CAROLINA FAMILY PRACTICE CENTRE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-485-1700
Mailing Address - Street 1:2500 VILLAGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3982
Mailing Address - Country:US
Mailing Address - Phone:910-476-6868
Mailing Address - Fax:910-484-2800
Practice Address - Street 1:2500 VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3982
Practice Address - Country:US
Practice Address - Phone:910-485-1700
Practice Address - Fax:910-484-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701262261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H06141Medicare UPIN