Provider Demographics
NPI:1396771564
Name:RED SPRINGS FAMILY MEDICINE CLINIC, PA
Entity type:Organization
Organization Name:RED SPRINGS FAMILY MEDICINE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-843-9991
Mailing Address - Street 1:229 S MAIN ST
Mailing Address - Street 2:PO BOX 391
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-1621
Mailing Address - Country:US
Mailing Address - Phone:910-843-9991
Mailing Address - Fax:910-843-9995
Practice Address - Street 1:229 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1621
Practice Address - Country:US
Practice Address - Phone:910-843-9991
Practice Address - Fax:910-843-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8931376Medicaid
NC8931376Medicaid
NCP59016Medicare UPIN