Provider Demographics
NPI:1952615510
Name:PARDEE FAMILY MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:PARDEE FAMILY MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:828-696-1000
Mailing Address - Street 1:PO BOX 63314
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 B CANE CREEK RD.
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-9707
Practice Address - Country:US
Practice Address - Phone:828-684-6035
Practice Address - Fax:828-654-8152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDERSON COUNTY HOSPITAL CORPORATION D/B/A PARDEE MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-05
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0185XOtherBLUE CROSS BLUE SHIELD
NC0185XOtherBLUE CROSS BLUE SHIELD