Provider Demographics
NPI:1518951045
Name:ASHEVILLE FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:ASHEVILLE FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYCISIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:TREAKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-252-8885
Mailing Address - Street 1:41 OAKLAND RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4820
Mailing Address - Country:US
Mailing Address - Phone:828-252-8885
Mailing Address - Fax:828-252-9420
Practice Address - Street 1:41 OAKLAND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4820
Practice Address - Country:US
Practice Address - Phone:828-252-8885
Practice Address - Fax:828-252-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01063OtherBLUE CROSS BLUE SHIELD
NC7901063Medicaid
NC0717Medicare PIN