Provider Demographics
NPI:1265709612
Name:NORTH MOORE FAMILY PRACTICE PA
Entity type:Organization
Organization Name:NORTH MOORE FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LACRECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REIVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-895-0579
Mailing Address - Street 1:301 S MIDDLETON ST
Mailing Address - Street 2:
Mailing Address - City:ROBBINS
Mailing Address - State:NC
Mailing Address - Zip Code:27325-8407
Mailing Address - Country:US
Mailing Address - Phone:910-948-2059
Mailing Address - Fax:910-948-2443
Practice Address - Street 1:301 S MIDDLETON ST
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:NC
Practice Address - Zip Code:27325-8407
Practice Address - Country:US
Practice Address - Phone:910-948-2059
Practice Address - Fax:910-948-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty