Provider Demographics
NPI:1740434604
Name:SEASIDE FAMILY MEDICINE P.A.
Entity type:Organization
Organization Name:SEASIDE FAMILY MEDICINE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-575-3923
Mailing Address - Street 1:710 SUNSET BLVD N
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUNSET BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28468-4345
Mailing Address - Country:US
Mailing Address - Phone:910-575-3923
Mailing Address - Fax:910-575-3926
Practice Address - Street 1:710 SUNSET BLVD N
Practice Address - Street 2:SUITE A
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468-4345
Practice Address - Country:US
Practice Address - Phone:910-575-3923
Practice Address - Fax:910-575-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152200261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care