Provider Demographics
NPI:1780643999
Name:CHADBOURN FAMILY PRACTICE CENTER PA
Entity Type:Organization
Organization Name:CHADBOURN FAMILY PRACTICE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-654-3143
Mailing Address - Street 1:104 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-1402
Mailing Address - Country:US
Mailing Address - Phone:910-654-3143
Mailing Address - Fax:910-654-4144
Practice Address - Street 1:104 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-1402
Practice Address - Country:US
Practice Address - Phone:910-654-3143
Practice Address - Fax:910-654-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343918AMedicaid
NC343918CMedicaid
NCB84829Medicare UPIN
NC343918Medicare ID - Type Unspecified
NC343918AMedicaid