Provider Demographics
NPI:1932137676
Name:DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC.
Entity Type:Organization
Organization Name:DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC.
Other - Org Name:HENDERSON FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-416-8103
Mailing Address - Street 1:PO BOX 110566
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-5566
Mailing Address - Country:US
Mailing Address - Phone:919-620-4855
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:480 RUIN CREEK RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2929
Practice Address - Country:US
Practice Address - Phone:252-492-3152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUKE UNIVERSITY AFFILIATED PHYSICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-29
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01701OtherBCBS GROUP NUMBER
NCCC3150Medicare PIN
NC2317755Medicare PIN
NCCA4002Medicare PIN