Provider Demographics
NPI:1710073606
Name:EAGLE PHYSICIANS AND ASSOCIATES PA
Entity Type:Organization
Organization Name:EAGLE PHYSICIANS AND ASSOCIATES PA
Other - Org Name:EAGLE FAMILY MEDICINE @ BRASSFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, EAGLE BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-268-3201
Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-282-0376
Mailing Address - Fax:336-282-0379
Practice Address - Street 1:3800 ROBERT PORCHER WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2190
Practice Address - Country:US
Practice Address - Phone:336-282-0376
Practice Address - Fax:336-282-0379
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE PHYSICIANS AND ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0287UOtherBCBS OF NC
NC890287UMedicaid
NC2318442Medicare PIN
NC890287UMedicaid