Provider Demographics
NPI:1982773206
Name:EAGLE PHYSICIANS AND ASSOCIATES PA
Entity type:Organization
Organization Name:EAGLE PHYSICIANS AND ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, EAGLE BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-268-3201
Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-644-0111
Mailing Address - Fax:336-644-0085
Practice Address - Street 1:1510 NC HIGHWAY 68 N
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9733
Practice Address - Country:US
Practice Address - Phone:336-644-0111
Practice Address - Fax:336-644-0085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE PHYSICIANS AND ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902757Medicaid
NC02757OtherBCBS OF NC
NC8902757Medicaid
NCCB9132Medicare PIN