Provider Demographics
NPI:1558320895
Name:FAMILY MEDICINE ASSOCIATES OF LINCOLN COUNTY, PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF LINCOLN COUNTY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-732-8736
Mailing Address - Street 1:1531 N ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7268
Mailing Address - Country:US
Mailing Address - Phone:704-732-8736
Mailing Address - Fax:704-732-8121
Practice Address - Street 1:1531 N ASPEN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-7268
Practice Address - Country:US
Practice Address - Phone:704-732-8736
Practice Address - Fax:704-732-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC119460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016RVOtherBLUE CROSS BLUE SHIELD-NC
NC89016RVMedicaid
NC2336327Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER