Basic Information
| Provider Information | |||||||||
| NPI: | 1003818485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HERITAGE FAMILY PHYSICIANS | ||||||||
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| OtherOrganizationName: | HEALTH PAVILION FAMILY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1638 OWEN DRIVE | ||||||||
| Address2: | ATTN: MANAGED CARE PLANNING | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106156949 | ||||||||
| FaxNumber: | 9106159761 | ||||||||
| Practice Location | |||||||||
| Address1: | 6387 RAMSEY ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106153920 | ||||||||
| FaxNumber: | 9103216221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 08/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | FISER | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9106155572 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H0213 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.