Provider Demographics
NPI:1487867347
Name:LAUREL CREEK FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:LAUREL CREEK FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:TOWNSEND
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-992-1234
Mailing Address - Street 1:900 OLD WINSTON RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8119
Mailing Address - Country:US
Mailing Address - Phone:336-992-1234
Mailing Address - Fax:336-993-9963
Practice Address - Street 1:900 OLD WINSTON RD
Practice Address - Street 2:SUITE 222
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-8119
Practice Address - Country:US
Practice Address - Phone:336-992-1234
Practice Address - Fax:336-993-9963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2346346Medicare ID - Type UnspecifiedLAUREL CREEK FAMILY MEDIC
NCG81129Medicare UPIN
NCI07723Medicare UPIN