MEDICARE: CONNER FAMILY HEALTH CLINIC, 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	207Q00000X	Family Medicine Physician	9701293	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2344531	OTHER		PTAN

General Provider Information

NPI Number	:	1992984066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNER FAMILY HEALTH CLINIC, PLLC

Provider Business Mailing Address
First Line	:	211 W MATTHEWS ST
Second Line	:	SUITE 102
City	:	MATTHEWS
State	:	NC
Zip	:	28105-1309
Country	:	US
Telephone Number	:	704-708-4301
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 W MATTHEWS ST
Second Line	:	SUITE 102
City	:	MATTHEWS
State	:	NC
Zip	:	28105-1309
Country	:	US
Telephone Number	:	704-708-4301
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM CONNER
Credential	:	M.D.
Telephone Number	:	704-708-4301

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	08/17/2010

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