Provider Demographics
NPI:1972719698
Name:CARRBORO FAMILY MEDICINE CENTER, PA
Entity type:Organization
Organization Name:CARRBORO FAMILY MEDICINE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-929-1747
Mailing Address - Street 1:610 JONES FERRY RD
Mailing Address - Street 2:STE 102
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-6113
Mailing Address - Country:US
Mailing Address - Phone:919-929-1747
Mailing Address - Fax:919-933-5168
Practice Address - Street 1:610 JONES FERRY RD
Practice Address - Street 2:STE 102
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-6113
Practice Address - Country:US
Practice Address - Phone:919-929-1747
Practice Address - Fax:919-933-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
NC25815261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1972719698Medicaid
NCC85303Medicare UPIN