Basic Information
| Provider Information | |||||||||
| NPI: | 1659335461 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY AND COMMUNITY MEDICINE OF ASHEBORO P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 N COX STREET | ||||||||
| Address2: | SUITE #20 | ||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272035566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366722044 | ||||||||
| FaxNumber: | 3366297349 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 N COX ST | ||||||||
| Address2: | SUITE #20 | ||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272035566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366722044 | ||||||||
| FaxNumber: | 3366297349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHYTE | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3366723200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 30518 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 012FW | 01 | NC | BCBS GROUP NUMBER | OTHER | 89012FW | 05 | NC | MEDICAID |