Provider Demographics
NPI:1235405887
Name:CHEROKEE INDIANS OF ROBESON COUNTY
Entity Type:Organization
Organization Name:CHEROKEE INDIANS OF ROBESON COUNTY
Other - Org Name:PREVENTIVE MEDICAL AND FOOT CARE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:910-587-6031
Mailing Address - Street 1:10723 NC HIGHWAY 211 W
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-9589
Mailing Address - Country:US
Mailing Address - Phone:910-587-6031
Mailing Address - Fax:
Practice Address - Street 1:10723 NC HIGHWAY 211 W
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-9589
Practice Address - Country:US
Practice Address - Phone:910-316-5477
Practice Address - Fax:910-395-0181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHEROKEE INDIANS OF ROBESON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-28
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty