Provider Demographics
NPI:1073665337
Name:SWANNANOA VALLEY FAMILY MEDICINE
Entity Type:Organization
Organization Name:SWANNANOA VALLEY FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANEY
Authorized Official - Middle Name:WOOD
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-686-5232
Mailing Address - Street 1:2296 US 70 HWY
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-8209
Mailing Address - Country:US
Mailing Address - Phone:828-686-5232
Mailing Address - Fax:828-686-7269
Practice Address - Street 1:2296 US 70 HWY
Practice Address - Street 2:
Practice Address - City:SWANNANOA
Practice Address - State:NC
Practice Address - Zip Code:28778-8209
Practice Address - Country:US
Practice Address - Phone:828-686-5232
Practice Address - Fax:828-686-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC210331OtherCIGNA
NC0170087OtherUNITED HEALTH CARE
NC152692OtherMID SOUTH
NC8948212Medicaid
NC48212 01649OtherBCBS
NC202648BMedicare ID - Type UnspecifiedPROVIDER #
NC2324786Medicare ID - Type UnspecifiedMCR GROUP #
NC8948212Medicaid