Provider Demographics
NPI:1508850587
Name:WEST COLUMBUS FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:WEST COLUMBUS FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-654-1701
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-0325
Mailing Address - Country:US
Mailing Address - Phone:910-654-1701
Mailing Address - Fax:910-654-5701
Practice Address - Street 1:110 N BROWN ST
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-1702
Practice Address - Country:US
Practice Address - Phone:910-654-1701
Practice Address - Fax:910-654-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
NC36494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344630AMedicaid
NC0247YOtherBCBS
NC344634AMedicaid
NC0247YOtherBCBS
NC344634AMedicaid
NC348909Medicare Oscar/Certification