Provider Demographics
NPI:1114028859
Name:COLUMBUS FAMILY MEDICAL PA
Entity Type:Organization
Organization Name:COLUMBUS FAMILY MEDICAL PA
Other - Org Name:BRUNSWICK FAMILY MEDICAL AT OCEAN ISLE BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:STEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-234-1686
Mailing Address - Street 1:PO BOX 859
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-0859
Mailing Address - Country:US
Mailing Address - Phone:910-642-9800
Mailing Address - Fax:910-642-9816
Practice Address - Street 1:712 VILLAGE RD SW STE 104
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-3449
Practice Address - Country:US
Practice Address - Phone:910-754-7607
Practice Address - Fax:910-754-7608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902118Medicaid
NC5902118Medicaid
NC2199836BMedicare PIN