Provider Demographics
NPI:1992037709
Name:PACK FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:PACK FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-862-7225
Mailing Address - Street 1:212 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-9163
Mailing Address - Country:US
Mailing Address - Phone:910-862-7225
Mailing Address - Fax:
Practice Address - Street 1:212 S PINE ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9163
Practice Address - Country:US
Practice Address - Phone:910-862-7225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
NC101844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184653610OtherNPI-FOR KAREN B PACK PA-C
2752917AMedicare PIN