Healthcare Provider Details

I. General information

NPI: 1831414150
Provider Name (Legal Business Name): ISLAND FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 NC HIGHWAY 210 E
HAMPSTEAD NC
28443-8988
US

IV. Provider business mailing address

P.O BOX 2400
SURF CITY NC
28445-2400
US

V. Phone/Fax

Practice location:
  • Phone: 910-329-9916
  • Fax: 910-329-9919
Mailing address:
  • Phone: 910-329-9916
  • Fax: 910-329-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32636
License Number StateNC

VIII. Authorized Official

Name: DR. JAMES S BLAIR III
Title or Position: PRESIDENT
Credential: MD
Phone: 910-329-9916