Basic Information
| Provider Information | |||||||||
| NPI: | 1356568927 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANDHILLS FAMILY PRACTICE P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1125 CARTHAGE ST | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273304162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197746023 | ||||||||
| FaxNumber: | 9197746023 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CHURCH STREET | ||||||||
| Address2: | |||||||||
| City: | BROADWAY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192589214 | ||||||||
| FaxNumber: | 9192586693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 12/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | INSURANCE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9197746023 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SANDHILLS FAMILY PRACTICE PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 890134A | 05 | NC | MEDICAID | 5921115 | 05 | NC | MEDICAID |