Provider Demographics
NPI:1023061140
Name:PHYSCIANS ELDERCARE
Entity type:Organization
Organization Name:PHYSCIANS ELDERCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER SPECIALIST SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-245-5403
Mailing Address - Street 1:8022 CHRISTMAS CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0700
Mailing Address - Country:US
Mailing Address - Phone:704-399-9576
Mailing Address - Fax:
Practice Address - Street 1:3880 VEST MILL RD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1323
Practice Address - Country:US
Practice Address - Phone:336-245-5403
Practice Address - Fax:336-251-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCSTUDENT363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicare ID - Type Unspecified