Provider Demographics
NPI:1194842245
Name:ALAMANCE FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:ALAMANCE FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-449-4030
Mailing Address - Street 1:812 W HAGGARD AVE
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9134
Mailing Address - Country:US
Mailing Address - Phone:336-449-4030
Mailing Address - Fax:336-449-5315
Practice Address - Street 1:812 W HAGGARD AVE
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9134
Practice Address - Country:US
Practice Address - Phone:336-449-4030
Practice Address - Fax:336-449-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC193400000XMedicaid
203825DOtherDR MEINDERT NIEMEYER INDIVIDUAL PROVIDER NUMBER