Provider Demographics
NPI:1376639674
Name:FHPG, LLC
Entity Type:Organization
Organization Name:FHPG, LLC
Other - Org Name:MONTGOMERY COUNTY SCHOOL BASED HEALTH CENTER-WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-715-4473
Mailing Address - Street 1:129 NC HIGHWAY 109 S
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27306-8941
Mailing Address - Country:US
Mailing Address - Phone:910-572-1979
Mailing Address - Fax:910-572-1961
Practice Address - Street 1:129 NCHIGHWAY 109 S
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:NC
Practice Address - Zip Code:27306-8941
Practice Address - Country:US
Practice Address - Phone:910-572-1979
Practice Address - Fax:910-572-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCTIN # -- SUFFIX 036OtherCHAMPUS TRICARE
NC011MJOtherBCBS
NC8701704Medicaid