Provider Demographics
NPI:1093787608
Name:SYLVA FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:SYLVA FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-586-4012
Mailing Address - Street 1:430 FISHER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-7700
Mailing Address - Country:US
Mailing Address - Phone:828-586-4012
Mailing Address - Fax:828-586-5162
Practice Address - Street 1:430 FISHER CREEK RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-7700
Practice Address - Country:US
Practice Address - Phone:828-586-4012
Practice Address - Fax:828-586-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902789Medicaid
NC7902789Medicaid