Provider Demographics
NPI:1235131426
Name:DAYSPRING FAMILY MEDICINE
Entity Type:Organization
Organization Name:DAYSPRING FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SACRINTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-623-5171
Mailing Address - Street 1:723 S VAN BUREN RD STE B
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5321
Mailing Address - Country:US
Mailing Address - Phone:336-623-5171
Mailing Address - Fax:336-627-5747
Practice Address - Street 1:723 S VAN BUREN RD STE B
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5321
Practice Address - Country:US
Practice Address - Phone:336-623-5171
Practice Address - Fax:336-627-5747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790112GMedicaid
NC2310817Medicare ID - Type UnspecifiedMEDICARE
NC790112GMedicaid