Provider Demographics
NPI:1912042920
Name:CAPE CARTERET FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:CAPE CARTERET FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:252-764-2121
Mailing Address - Street 1:1057 CEDAR POINT BLVD
Mailing Address - Street 2:UNIT D
Mailing Address - City:CEDAR POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8020
Mailing Address - Country:US
Mailing Address - Phone:252-764-2121
Mailing Address - Fax:252-764-2135
Practice Address - Street 1:1057 CEDAR POINT BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8020
Practice Address - Country:US
Practice Address - Phone:252-764-2121
Practice Address - Fax:252-764-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004401Medicaid
NC7004401Medicaid