Basic Information
| Provider Information | |||||||||
| NPI: | 1982701215 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST COLUMBUS FAMILY PRACTICE, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 N BROWN ST | ||||||||
| Address2: | |||||||||
| City: | CHADBOURN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284311716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106541701 | ||||||||
| FaxNumber: | 9106545701 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 N BROWN ST | ||||||||
| Address2: | |||||||||
| City: | CHADBOURN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284311716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106541701 | ||||||||
| FaxNumber: | 9106545701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 10/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | BEAVER | ||||||||
| AuthorizedOfficialFirstName: | JOYCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9106541701 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 344634A | 05 | NC | MEDICAID | 344634C | 05 | NC | MEDICAID |