Provider Demographics
NPI:1396854238
Name:RAEFORD HOKE FAMILY CARE CENTER, P.A.
Entity Type:Organization
Organization Name:RAEFORD HOKE FAMILY CARE CENTER, P.A.
Other - Org Name:CUMBERLAND FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MITHU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-424-2426
Mailing Address - Street 1:PO BOX 1647
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:NC
Mailing Address - Zip Code:28729-1647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:910-424-7916
Practice Address - Street 1:2414 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4264
Practice Address - Country:US
Practice Address - Phone:919-424-2426
Practice Address - Fax:910-424-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013RKMedicaid
NC0132XOtherBCBS
NC0132XOtherBCBS
NC2313548Medicare PIN