Provider Demographics
NPI:1841455755
Name:JOHNSTON PRIMARY CARE PHYSICIAN SERVICES INC
Entity type:Organization
Organization Name:JOHNSTON PRIMARY CARE PHYSICIAN SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-934-8171
Mailing Address - Street 1:PO BOX 1376
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-1376
Mailing Address - Country:US
Mailing Address - Phone:919-938-7442
Mailing Address - Fax:
Practice Address - Street 1:514 N BRIGHTLEAF BLVD
Practice Address - Street 2:SUITE 1702
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-938-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSTON MEMORIAL HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-21
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty