Provider Demographics
NPI:1386682367
Name:EAST ASHEVILLE FAMILY HEALTH CARE P.A.
Entity Type:Organization
Organization Name:EAST ASHEVILLE FAMILY HEALTH CARE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:FORE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:828-298-7981
Mailing Address - Street 1:997 OLD US HWY 70 W STE A
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-4505
Mailing Address - Country:US
Mailing Address - Phone:828-298-7981
Mailing Address - Fax:828-298-6010
Practice Address - Street 1:997 OLD US HWY 70 W STE A
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-4505
Practice Address - Country:US
Practice Address - Phone:828-298-7981
Practice Address - Fax:828-298-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2344381OtherMEDICARE
NCCH2430OtherRAILROAD MEDICARE
NC154699OtherWELLCARE
NC02742OtherBCBS NC
NC790294QMedicaid
NCX275OtherBLUE MEDICARE