Provider Demographics
NPI:1710029152
Name:CARY FAMILY HEALTHCARE, PA
Entity Type:Organization
Organization Name:CARY FAMILY HEALTHCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-467-5678
Mailing Address - Street 1:115 CRESCENT COMMONS DR
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8102
Mailing Address - Country:US
Mailing Address - Phone:919-467-5678
Mailing Address - Fax:919-467-1948
Practice Address - Street 1:115 CRESCENT COMMONS DR
Practice Address - Street 2:SUITE # 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8102
Practice Address - Country:US
Practice Address - Phone:919-467-5678
Practice Address - Fax:919-467-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2328241Medicare PIN
NCE99663Medicare UPIN
NCG82189Medicare UPIN
NCG02500Medicare UPIN