Basic Information
| Provider Information | |||||||||
| NPI: | 1578989463 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASHE FAMILY HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 952 US HIGHWAY 221 BUS | ||||||||
| Address2: | PO BOX 70 | ||||||||
| City: | WEST JEFFERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286948137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368466100 | ||||||||
| FaxNumber: | 3368467900 | ||||||||
| Practice Location | |||||||||
| Address1: | 952 US HIGHWAY 221 BUS | ||||||||
| Address2: | |||||||||
| City: | WEST JEFFERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286948137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368466100 | ||||||||
| FaxNumber: | 3368467900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2014 | ||||||||
| LastUpdateDate: | 03/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | MCCLURE | ||||||||
| AuthorizedOfficialFirstName: | DEREK | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3368466100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 7003818 | 05 | NC | MEDICAID |