Provider Demographics
NPI:1700922937
Name:ANSON FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:ANSON FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-694-9440
Mailing Address - Street 1:510 MORVEN RD
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2745
Mailing Address - Country:US
Mailing Address - Phone:704-694-9440
Mailing Address - Fax:704-694-9440
Practice Address - Street 1:510 MORVEN RD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2745
Practice Address - Country:US
Practice Address - Phone:704-694-9440
Practice Address - Fax:704-694-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343948A&CMedicaid
NC343948A&CMedicaid