Provider Demographics
NPI:1134311723
Name:FAMILY HEALTHCARE PRACTICE PLLC
Entity Type:Organization
Organization Name:FAMILY HEALTHCARE PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOODIN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:828-466-3000
Mailing Address - Street 1:130 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-2106
Mailing Address - Country:US
Mailing Address - Phone:828-466-3000
Mailing Address - Fax:828-464-3281
Practice Address - Street 1:130 1ST ST W
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2106
Practice Address - Country:US
Practice Address - Phone:828-466-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC36195OtherBCBS
NC5915750Medicaid
NC8936195Medicaid
NC36195OtherBCBS