Provider Demographics
NPI:1942301676
Name:FAMILY CARE OF FAIRVIEW, PA
Entity Type:Organization
Organization Name:FAMILY CARE OF FAIRVIEW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:HOLT
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-296-0880
Mailing Address - Street 1:136 CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-9673
Mailing Address - Country:US
Mailing Address - Phone:828-296-0880
Mailing Address - Fax:828-296-0855
Practice Address - Street 1:136 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-9673
Practice Address - Country:US
Practice Address - Phone:828-296-0880
Practice Address - Fax:828-296-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012TAMedicaid
NC012TAOtherBCBS
NC012TAOtherBCBS