Provider Demographics
NPI:1508919283
Name:ROCKY MOUNT FAMILY MEDICAL CENTER PA
Entity Type:Organization
Organization Name:ROCKY MOUNT FAMILY MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR ASST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-443-3133
Mailing Address - Street 1:804 ENGLISH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6032
Mailing Address - Country:US
Mailing Address - Phone:252-443-3133
Mailing Address - Fax:252-443-6726
Practice Address - Street 1:804 ENGLISH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-6032
Practice Address - Country:US
Practice Address - Phone:252-443-3133
Practice Address - Fax:252-443-6726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890246AMedicaid
NC890246AMedicaid
NC0211630001Medicare NSC