Basic Information
Provider Information | |||||||||
NPI: | 1780653279 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SANDHILLS FAMILY PRACTICE PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1125 CARTHAGE ST | ||||||||
Address2: |   | ||||||||
City: | SANFORD | ||||||||
State: | NC | ||||||||
PostalCode: | 273304162 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9197746023 | ||||||||
FaxNumber: | 9197766359 | ||||||||
Practice Location | |||||||||
Address1: | 1125 CARTHAGE ST | ||||||||
Address2: |   | ||||||||
City: | SANFORD | ||||||||
State: | NC | ||||||||
PostalCode: | 273304162 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9197746023 | ||||||||
FaxNumber: | 9197766359 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/16/2006 | ||||||||
LastUpdateDate: | 03/15/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | THOMPSON | ||||||||
AuthorizedOfficialFirstName: | ROBIN | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | INSURANCE MANAGER | ||||||||
AuthorizedOfficialTelephone: | 9197746023 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | CMOM | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X |   | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 5921115 | 05 | NC |   | MEDICAID | 5922275 | 05 | NC |   | MEDICAID | 02286 | 01 | NC | BCBSNC PROVIDER NUMBER | OTHER | 7902286 | 05 | NC |   | MEDICAID |