Provider Demographics
NPI:1508918293
Name:CHRISTOPHERSON FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:CHRISTOPHERSON FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-2276
Mailing Address - Street 1:319 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1221
Mailing Address - Country:US
Mailing Address - Phone:704-403-2680
Mailing Address - Fax:704-784-4346
Practice Address - Street 1:319 PENNY LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1221
Practice Address - Country:US
Practice Address - Phone:704-403-2680
Practice Address - Fax:704-784-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC011JEOtherBCBS NC OLD GROUP#
NC5905765OtherMEDICAID OLD GROUP NUMBER
NCDF5941OtherRAILROAD MEDICARE PTAN, GROUP
NC892247AOtherMEDICAID OLD GROUP NUMBER
NC5906984Medicaid
NC892247AOtherMEDICAID OLD GROUP NUMBER
NC2342854Medicare PIN