Healthcare Provider Details

I. General information

NPI: 1447251103
Provider Name (Legal Business Name): TABOR CITY FAMILY MEDICINE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 PIREWAY RD
TABOR CITY NC
28463-8942
US

IV. Provider business mailing address

3439 CASEY ST
LORIS SC
29569-2903
US

V. Phone/Fax

Practice location:
  • Phone: 910-653-2112
  • Fax: 910-653-2346
Mailing address:
  • Phone: 843-756-5300
  • Fax: 843-756-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KIM FORD
Title or Position: INS. REP
Credential:
Phone: 843-756-5300