Provider Demographics
NPI:1417018565
Name:MASONBORO FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:MASONBORO FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-790-3660
Mailing Address - Street 1:6419 CAROLINA BEACH ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2788
Mailing Address - Country:US
Mailing Address - Phone:910-790-3660
Mailing Address - Fax:
Practice Address - Street 1:6419 CAROLINA BEACH ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2788
Practice Address - Country:US
Practice Address - Phone:910-790-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC051C3OtherBCBS
NC18265OtherBCBS
NC015C3Medicaid
NC10892OtherBCBS NC
NC61634OtherBCBS
NC87545OtherBCBS
NC8910892Medicaid
NC8961634Medicaid
NC87545OtherBCBS
NC61634OtherBCBS
NCF36078Medicare UPIN
NC1022110001Medicare NSC
NCS62999Medicare UPIN
NCG06165Medicare UPIN
C85249Medicare UPIN
NC8961634Medicaid
2335346Medicare PIN
NCS83378Medicare UPIN
NC201605BMedicare PIN