Provider Demographics
NPI:1922193622
Name:WHITE OAK FAMILY PHYSICIANS, PA
Entity Type:Organization
Organization Name:WHITE OAK FAMILY PHYSICIANS, PA
Other - Org Name:WHITE OAK URGENT CARE ASHEBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:336-625-1360
Mailing Address - Street 1:550 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4710
Mailing Address - Country:US
Mailing Address - Phone:336-625-1360
Mailing Address - Fax:336-625-1889
Practice Address - Street 1:197 B HIGHWAY 42 NORTH
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203
Practice Address - Country:US
Practice Address - Phone:336-625-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790249YMedicaid
NC0249YOtherBCBS GROUP NUMBER
NC790249YMedicaid