Provider Demographics
NPI:1609178342
Name:UNIFOUR FAMILY HEALTH CARE LLC
Entity Type:Organization
Organization Name:UNIFOUR FAMILY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:STARNES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:828-855-3644
Mailing Address - Street 1:1205 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3759
Mailing Address - Country:US
Mailing Address - Phone:828-855-3644
Mailing Address - Fax:828-855-3351
Practice Address - Street 1:1205 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3759
Practice Address - Country:US
Practice Address - Phone:828-855-3644
Practice Address - Fax:828-855-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200529363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000108Medicaid