Provider Demographics
NPI:1811226871
Name:CLEVELAND FAMILY HEALTH, PA
Entity Type:Organization
Organization Name:CLEVELAND FAMILY HEALTH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:WILDER
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-662-7600
Mailing Address - Street 1:22 SHIPWASH DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6861
Mailing Address - Country:US
Mailing Address - Phone:919-662-7600
Mailing Address - Fax:919-662-7675
Practice Address - Street 1:22 SHIPWASH DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6861
Practice Address - Country:US
Practice Address - Phone:919-662-7600
Practice Address - Fax:919-662-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0032470261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1858639OtherUHC
NC8917359Medicaid
NC17359OtherBCBS
NC212959FOtherPTAN
NC7807067OtherAETNA
NC7807067OtherAETNA