Provider Demographics
NPI:1700280062
Name:BACK TO BASICS FAMILY PRACTICE CLINIC, PLLC
Entity type:Organization
Organization Name:BACK TO BASICS FAMILY PRACTICE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:336-446-1141
Mailing Address - Street 1:941 CENTER CREST DR
Mailing Address - Street 2:STE C
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-8001
Mailing Address - Country:US
Mailing Address - Phone:336-446-1141
Mailing Address - Fax:336-446-0346
Practice Address - Street 1:941 CENTER CREST DR
Practice Address - Street 2:STE C
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-8001
Practice Address - Country:US
Practice Address - Phone:336-446-1141
Practice Address - Fax:336-446-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care