Provider Demographics
NPI:1821053307
Name:FAMILY MEDICINE OF HARNETT COUNTY, INCORPRATED
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF HARNETT COUNTY, INCORPRATED
Other - Org Name:HARNETT FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:BLACKWELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-897-5521
Mailing Address - Street 1:901 DENIM DR
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-2307
Mailing Address - Country:US
Mailing Address - Phone:910-897-5521
Mailing Address - Fax:910-897-2003
Practice Address - Street 1:901 DENIM DR
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-2307
Practice Address - Country:US
Practice Address - Phone:910-897-5521
Practice Address - Fax:910-897-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200801349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014FTMedicaid
NC89014FTMedicaid
NCI01864Medicare UPIN