Provider Demographics
NPI:1396859872
Name:BRUNSWICK FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:BRUNSWICK FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SLADE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SUCHECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-454-4343
Mailing Address - Street 1:3960 EXECUTIVE PARK BLVD
Mailing Address - Street 2:UNIT 600
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461
Mailing Address - Country:US
Mailing Address - Phone:910-454-4343
Mailing Address - Fax:910-457-9209
Practice Address - Street 1:3960 EXECUTIVE PARK BLVD
Practice Address - Street 2:UNIT 600
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461
Practice Address - Country:US
Practice Address - Phone:910-454-4343
Practice Address - Fax:910-457-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty