Provider Demographics
NPI:1134106032
Name:FAMILY PRACTICE OF SUMMERFIELD PLLC
Entity Type:Organization
Organization Name:FAMILY PRACTICE OF SUMMERFIELD PLLC
Other - Org Name:DRS BURNETT KAPLAN & WILSON LLP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-643-7711
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-0220
Mailing Address - Country:US
Mailing Address - Phone:336-643-7711
Mailing Address - Fax:336-643-3047
Practice Address - Street 1:4431 HIGHWAY 220 NORTH
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9411
Practice Address - Country:US
Practice Address - Phone:336-643-7711
Practice Address - Fax:336-643-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901586Medicaid
NC8901586Medicaid
NCW70715Medicare UPIN