Provider Demographics
NPI:1295063279
Name:LOUISBURG FAMILY PRACTICE AND PAIN MANAGEMENT PLLC
Entity type:Organization
Organization Name:LOUISBURG FAMILY PRACTICE AND PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-496-1247
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-0239
Mailing Address - Country:US
Mailing Address - Phone:919-496-1247
Mailing Address - Fax:919-496-3307
Practice Address - Street 1:1501 N BICKETT BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2178
Practice Address - Country:US
Practice Address - Phone:919-496-1247
Practice Address - Fax:919-496-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25447208VP0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty