Provider Demographics
NPI:1184757346
Name:CENTRAL FAMILY PRACTICE
Entity type:Organization
Organization Name:CENTRAL FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-688-5561
Mailing Address - Street 1:507 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4427
Mailing Address - Country:US
Mailing Address - Phone:919-688-5561
Mailing Address - Fax:919-688-5563
Practice Address - Street 1:507 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-4427
Practice Address - Country:US
Practice Address - Phone:919-688-5561
Practice Address - Fax:919-688-5563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17981261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901240Medicaid
NCC84349Medicare UPIN
NC1007Medicare ID - Type UnspecifiedFAMILY PRATICE