Provider Demographics
NPI:1114688223
Name:SMITH & KOLB FAMILY PRACTICE, PLLC
Entity Type:Organization
Organization Name:SMITH & KOLB FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BUFFY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-740-4361
Mailing Address - Street 1:413 OWEN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3490
Mailing Address - Country:US
Mailing Address - Phone:910-740-4361
Mailing Address - Fax:910-488-4856
Practice Address - Street 1:413 OWEN DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3490
Practice Address - Country:US
Practice Address - Phone:910-740-4361
Practice Address - Fax:910-488-4856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1437827490OtherNATIONAL PROVIDER IDENTIFIER