Provider Demographics
NPI:1710963335
Name:FAMILY CARE ASSOCIATES OF MONTGOMERY COUNTY PA
Entity Type:Organization
Organization Name:FAMILY CARE ASSOCIATES OF MONTGOMERY COUNTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MONTGOMERY
Authorized Official - Last Name:WOODYEAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-576-0042
Mailing Address - Street 1:507 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-2709
Mailing Address - Country:US
Mailing Address - Phone:910-576-0042
Mailing Address - Fax:910-576-1442
Practice Address - Street 1:507 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2709
Practice Address - Country:US
Practice Address - Phone:910-576-0042
Practice Address - Fax:910-576-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMD#9500278174400000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0271RMedicaid
NC=========OtherCOMMERCIAL
NC2339076Medicare ID - Type Unspecified
NCE52514Medicare UPIN