Provider Demographics
NPI:1841275898
Name:BELHAVEN FAMILY PRACTICE, PA
Entity type:Organization
Organization Name:BELHAVEN FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-943-6114
Mailing Address - Street 1:161 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:BELHAVEN
Mailing Address - State:NC
Mailing Address - Zip Code:27810-1424
Mailing Address - Country:US
Mailing Address - Phone:252-943-3114
Mailing Address - Fax:252-943-3281
Practice Address - Street 1:161 E WATER ST
Practice Address - Street 2:
Practice Address - City:BELHAVEN
Practice Address - State:NC
Practice Address - Zip Code:27810-1424
Practice Address - Country:US
Practice Address - Phone:252-943-3114
Practice Address - Fax:252-943-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890125YMedicaid
NC0125YOtherBC OF NC
NC230841Medicare ID - Type Unspecified