Provider Demographics
NPI:1609188044
Name:LAUREL HILL FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:LAUREL HILL FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-462-4624
Mailing Address - Street 1:9241 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28351-9361
Mailing Address - Country:US
Mailing Address - Phone:910-462-4624
Mailing Address - Fax:910-462-4627
Practice Address - Street 1:9241 MORGAN ST
Practice Address - Street 2:
Practice Address - City:LAUREL HILL
Practice Address - State:NC
Practice Address - Zip Code:28351-9361
Practice Address - Country:US
Practice Address - Phone:910-462-4624
Practice Address - Fax:910-462-4627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0418100261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD73592Medicare UPIN