Provider Demographics
NPI:1295818441
Name:CAROLINA PREMIER HEALTH CARE PA
Entity Type:Organization
Organization Name:CAROLINA PREMIER HEALTH CARE PA
Other - Org Name:FAMILY CARE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-693-1698
Mailing Address - Street 1:630 S BENNETT STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28384
Mailing Address - Country:US
Mailing Address - Phone:910-693-1678
Mailing Address - Fax:910-693-1612
Practice Address - Street 1:630 S BENNETT STREET
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28384
Practice Address - Country:US
Practice Address - Phone:910-693-1678
Practice Address - Fax:910-693-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
022757OtherDOCTORS HEALTH PLAN
NC01241OtherGROUP BCBS
NC80897OtherBCBS
56142OtherHEALTHCARE SAVINGS
NC8980897Medicaid
NCFH2000455OtherFIRST CAROLINA CARE
NC89012H1Medicaid
NC2142636CMedicare ID - Type Unspecified
022757OtherDOCTORS HEALTH PLAN
NC80897OtherBCBS