Provider Demographics
NPI:1952305401
Name:CNC FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:CNC FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:BUCKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-428-1111
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:NC
Mailing Address - Zip Code:27356-0190
Mailing Address - Country:US
Mailing Address - Phone:910-428-1111
Mailing Address - Fax:910-428-2506
Practice Address - Street 1:128 OKEEWEMEE STAR RD
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:NC
Practice Address - Zip Code:27356-7343
Practice Address - Country:US
Practice Address - Phone:910-428-1111
Practice Address - Fax:910-428-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015AVMedicaid
NC89015AVMedicaid