MEDICARE: DENVER FAMILY HEALTHCARE,PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2592397A	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1285886424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENVER FAMILY HEALTHCARE,PLLC

Provider Business Mailing Address
First Line	:	108 W MOUNTAIN ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3413
Country	:	US
Telephone Number	:	704-739-5550
Fax Number	:	800-317-3563

Provider Business Practice Location Address
First Line	:	108 W MOUNTAIN ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3413
Country	:	US
Telephone Number	:	704-739-5550
Fax Number	:	800-317-3563

Authorized Official
Title or Position	:	OWNER/FAMILY NURSE PRACTITIONER
Name	:	MRS. VIRGINIA B ERVIN
Credential	:	MSN, FNP-BC
Telephone Number	:	704-739-5550

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	07/08/2013

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