Provider Demographics
NPI:1558633651
Name:OUTER BANKS FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:OUTER BANKS FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-441-5038
Mailing Address - Street 1:2522 S CROATAN HWY
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-8809
Mailing Address - Country:US
Mailing Address - Phone:252-441-5038
Mailing Address - Fax:252-441-5216
Practice Address - Street 1:2522 S CROATAN HWY
Practice Address - Street 2:SUITE 1-B
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8809
Practice Address - Country:US
Practice Address - Phone:252-441-5038
Practice Address - Fax:252-441-5216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601219261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891080UMedicaid
NC1080UOtherBLUE CROSS BLUE SHIELD
NC2246026BMedicare PIN