Provider Demographics
NPI:1265495881
Name:SPINDALE FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:SPINDALE FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRILL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:WASHBURN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:828-287-0200
Mailing Address - Street 1:144 RESERVATION DR
Mailing Address - Street 2:
Mailing Address - City:SPINDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28160-1566
Mailing Address - Country:US
Mailing Address - Phone:828-288-7777
Mailing Address - Fax:828-287-8755
Practice Address - Street 1:144 RESERVATION DR
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-1566
Practice Address - Country:US
Practice Address - Phone:828-287-0200
Practice Address - Fax:828-287-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2402725207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890266EMedicaid
NC0266EOtherBCBS
NC2311458Medicare ID - Type Unspecified
NC890266EMedicaid