Provider Demographics
NPI:1497908925
Name:FAMILY CARE CENTER, P.A
Entity Type:Organization
Organization Name:FAMILY CARE CENTER, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-632-9736
Mailing Address - Street 1:1668 NC HIGHWAY 16 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-6285
Mailing Address - Country:US
Mailing Address - Phone:828-632-9736
Mailing Address - Fax:828-632-9544
Practice Address - Street 1:1668 NC HIGHWAY 16 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-6285
Practice Address - Country:US
Practice Address - Phone:828-632-9736
Practice Address - Fax:828-632-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC348932CMedicaid