Basic Information
| Provider Information | |||||||||
| NPI: | 1790803898 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EL FUTURO, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 CHAPEL HILL RD STE 23 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277071186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196887101 | ||||||||
| FaxNumber: | 9196887102 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 CHAPEL HILL RD. | ||||||||
| Address2: | SUITE 23 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196887101 | ||||||||
| FaxNumber: | 9196887102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 01/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | LUKE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9196887101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | SL003464 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 018A5 | 01 | NC | NC BLUECROSS BLUESHIELD | OTHER | 3579 | 01 | NC | IPRS ID NUMBER | OTHER | 6005688 | 05 | NC | MEDICAID |