Provider Demographics
NPI:1437307832
Name:LANDFALL FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:LANDFALL FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:910-772-2092
Mailing Address - Street 1:5710 OLEANDER DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4766
Mailing Address - Country:US
Mailing Address - Phone:910-772-2092
Mailing Address - Fax:910-772-2093
Practice Address - Street 1:5710 OLEANDER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4766
Practice Address - Country:US
Practice Address - Phone:910-772-2092
Practice Address - Fax:910-772-2093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104190363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335834Medicare PIN