Provider Demographics
NPI:1952493587
Name:PERSON FAMILY MEDICAL CENTER INCORPORATED
Entity Type:Organization
Organization Name:PERSON FAMILY MEDICAL CENTER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-599-2900
Mailing Address - Street 1:702 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573
Mailing Address - Country:US
Mailing Address - Phone:336-599-9271
Mailing Address - Fax:
Practice Address - Street 1:702 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4755
Practice Address - Country:US
Practice Address - Phone:336-599-9271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02385OtherBCBS OF NC
NC344504AMedicaid
NC02385OtherBCBS/NC
NC341814Medicare PIN
341814Medicare ID - Type UnspecifiedUGS MEDICARE GROUP NUMBER
NC344504AMedicaid
NC02385OtherBCBS OF NC