Provider Demographics
NPI:1881871622
Name:EASTOVER FAMILY CARE PC
Entity type:Organization
Organization Name:EASTOVER FAMILY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:910-483-6277
Mailing Address - Street 1:3947 DUNN RD # 304
Mailing Address - Street 2:
Mailing Address - City:EASTOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28312-8533
Mailing Address - Country:US
Mailing Address - Phone:910-483-6277
Mailing Address - Fax:910-483-6285
Practice Address - Street 1:3551 DUNN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EASTOVER
Practice Address - State:NC
Practice Address - Zip Code:28312-8794
Practice Address - Country:US
Practice Address - Phone:910-483-6277
Practice Address - Fax:910-483-6285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335746OtherMEDICARE
NC5908812Medicaid