Provider Demographics
NPI:1528526886
Name:MARY CATHERINE MCCORMICK BROWNE
Entity type:Organization
Organization Name:MARY CATHERINE MCCORMICK BROWNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:MCCORMICK BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:336-701-3237
Mailing Address - Street 1:1736 SWAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27020-8305
Mailing Address - Country:US
Mailing Address - Phone:336-701-3237
Mailing Address - Fax:
Practice Address - Street 1:955 W MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:NC
Practice Address - Zip Code:28634-9352
Practice Address - Country:US
Practice Address - Phone:336-701-3237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
12115OtherNON VA COMMUNITY PROVIDER