Provider Demographics
NPI:1356568927
Name:SANDHILLS FAMILY PRACTICE P A
Entity type:Organization
Organization Name:SANDHILLS FAMILY PRACTICE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-774-6023
Mailing Address - Street 1:1125 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4162
Mailing Address - Country:US
Mailing Address - Phone:919-774-6023
Mailing Address - Fax:919-774-6023
Practice Address - Street 1:101 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:NC
Practice Address - Zip Code:27505
Practice Address - Country:US
Practice Address - Phone:919-258-9214
Practice Address - Fax:919-258-6693
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDHILLS FAMILY PRACTICE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890134AMedicaid
NC5921115Medicaid
NC230433AMedicare PIN