Basic Information
| Provider Information | |||||||||
| NPI: | 1265495881 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPINDALE FAMILY PRACTICE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 144 RESERVATION DR | ||||||||
| Address2: | |||||||||
| City: | SPINDALE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281601566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282887777 | ||||||||
| FaxNumber: | 8282878755 | ||||||||
| Practice Location | |||||||||
| Address1: | 144 RESERVATION DR | ||||||||
| Address2: | |||||||||
| City: | SPINDALE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281601566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282870200 | ||||||||
| FaxNumber: | 8282878755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 06/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | WASHBURN | ||||||||
| AuthorizedOfficialFirstName: | HARRILL | ||||||||
| AuthorizedOfficialMiddleName: | GENE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8282870200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2402725 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 890266E | 05 | NC | MEDICAID | 0266E | 01 | NC | BCBS | OTHER |