Provider Demographics
NPI:1639294457
Name:CARTERET FAMILY PRACTICE CLINIC
Entity Type:Organization
Organization Name:CARTERET FAMILY PRACTICE CLINIC
Other - Org Name:CARTERET FAMILY PRACTICE PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:REECE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:252-247-5177
Mailing Address - Street 1:208A PENNY LN
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4305
Mailing Address - Country:US
Mailing Address - Phone:252-247-5177
Mailing Address - Fax:252-247-0223
Practice Address - Street 1:208A PENNY LN
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4305
Practice Address - Country:US
Practice Address - Phone:252-247-5177
Practice Address - Fax:252-247-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18559207Q00000X, 332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0165406Medicaid