Provider Demographics
NPI:1629156963
Name:FOOTHILLS FAMILY HEALTH CARE
Entity Type:Organization
Organization Name:FOOTHILLS FAMILY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:FERRELL
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:828-245-3158
Mailing Address - Street 1:249 OAK ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-3585
Mailing Address - Country:US
Mailing Address - Phone:828-245-3158
Mailing Address - Fax:828-247-6484
Practice Address - Street 1:249 OAK ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3585
Practice Address - Country:US
Practice Address - Phone:828-245-3158
Practice Address - Fax:828-247-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC700004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013K4OtherBCBS PROVIDER NUMBER
NC89013K4Medicaid
NC2593975DMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER