Provider Demographics
NPI:1982674859
Name:WEAVERVILLE FAMILY MEDICINE ASSOCIATES, PA
Entity Type:Organization
Organization Name:WEAVERVILLE FAMILY MEDICINE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-645-3066
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-0950
Mailing Address - Country:US
Mailing Address - Phone:828-645-3066
Mailing Address - Fax:828-658-1445
Practice Address - Street 1:63 MONTICELLO RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9441
Practice Address - Country:US
Practice Address - Phone:828-645-3066
Practice Address - Fax:828-658-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC64-71306OtherUHC PHYSICAL THERAPY
NC8902921Medicaid
NC02921OtherBC/BS
NC230401Medicare PIN
NC0144030001Medicare NSC
NCC31272Medicare PIN