Provider Demographics
NPI:1720094543
Name:COMMUNITY FAMILY MEDICINE AND OBSTETRICS, P.A.
Entity Type:Organization
Organization Name:COMMUNITY FAMILY MEDICINE AND OBSTETRICS, P.A.
Other - Org Name:CHATHAM FAMILY PHYSICIANS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-776-6000
Mailing Address - Street 1:2412 WILKINS DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-7268
Mailing Address - Country:US
Mailing Address - Phone:919-776-6000
Mailing Address - Fax:919-776-1751
Practice Address - Street 1:2412 WILKINS DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-7268
Practice Address - Country:US
Practice Address - Phone:919-776-6000
Practice Address - Fax:919-776-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890217GMedicaid
NC8901474Medicaid
NC890217GMedicaid
NCCA6682Medicare PIN
NCCG5953Medicare PIN
NC230786Medicare PIN