Provider Demographics
NPI:1497755953
Name:MID CAROLINA FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:MID CAROLINA FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOUBER
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-572-1785
Mailing Address - Street 1:1038 ALBEMARLE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-8684
Mailing Address - Country:US
Mailing Address - Phone:910-572-1785
Mailing Address - Fax:910-572-1410
Practice Address - Street 1:1038 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-8685
Practice Address - Country:US
Practice Address - Phone:910-572-1785
Practice Address - Fax:910-572-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201193207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34-8951 A/CMedicaid
NCP00246988OtherRAILROAD MEDICARE
NCP00246988OtherRAILROAD MEDICARE
NC34-8951 A/CMedicaid
NC2346924Medicare PIN
NC34-8951Medicare PIN