Basic Information
| Provider Information | |||||||||
| NPI: | 1225143936 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STONY POINT FAMILY MEDICINE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 RURITAN PARK RD | ||||||||
| Address2: | |||||||||
| City: | STONY POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286788928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045859373 | ||||||||
| FaxNumber: | 7045859397 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 RURITAN PARK RD | ||||||||
| Address2: | |||||||||
| City: | STONY POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286788928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045859373 | ||||||||
| FaxNumber: | 7045859397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 07/24/2013 | ||||||||
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| AuthorizedOfficialLastName: | SWEDLUND | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7045859373 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 014Y5 | 01 | NC | BCBS OF NC | OTHER | 8103117 | 05 | NC | MEDICAID | I679 | 01 | NC | PARTNERS | OTHER |