Provider Demographics
NPI:1831168103
Name:MEDICAL ARTS FAMILY PRACTICE, PA
Entity type:Organization
Organization Name:MEDICAL ARTS FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-323-9111
Mailing Address - Street 1:413 OWEN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3411
Mailing Address - Country:US
Mailing Address - Phone:910-323-9111
Mailing Address - Fax:910-484-2535
Practice Address - Street 1:413 OWEN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3411
Practice Address - Country:US
Practice Address - Phone:910-323-9111
Practice Address - Fax:910-484-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
207Q00000XOtherTAXONOMY
207Q00000XOtherTAXONOMY