Provider Demographics
NPI:1972989598
Name:CAPE FEAR FAMILY MEDICAL CARE,PA
Entity Type:Organization
Organization Name:CAPE FEAR FAMILY MEDICAL CARE,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-323-3183
Mailing Address - Street 1:1340 WALTER REED RD
Mailing Address - Street 2:MED ONE SLEEP CENTER
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4448
Mailing Address - Country:US
Mailing Address - Phone:910-323-3183
Mailing Address - Fax:910-223-7555
Practice Address - Street 1:1340 WALTER REED RD
Practice Address - Street 2:MED ONE SLEEP CENTER
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4448
Practice Address - Country:US
Practice Address - Phone:910-323-3183
Practice Address - Fax:910-223-7555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPE FEAR FAMILY MEDICAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-05
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20544207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901245Medicaid
NC230686Medicare UPIN