Healthcare Provider Details

I. General information

NPI: 1952615510
Provider Name (Legal Business Name): PARDEE FAMILY MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 B CANE CREEK RD.
FLETCHER NC
28732-9707
US

IV. Provider business mailing address

PO BOX 63314
CHARLOTTE NC
28263-3314
US

V. Phone/Fax

Practice location:
  • Phone: 828-684-6035
  • Fax: 828-654-8152
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN D HOUSE
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 828-696-1000