Healthcare Provider Details

I. General information

NPI: 1497755953
Provider Name (Legal Business Name): MID CAROLINA FAMILY MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 ALBEMARLE RD
TROY NC
27371-8685
US

IV. Provider business mailing address

1038 ALBEMARLE RD
TROY NC
27371-8684
US

V. Phone/Fax

Practice location:
  • Phone: 910-572-1785
  • Fax: 910-572-1410
Mailing address:
  • Phone: 910-572-1785
  • Fax: 910-572-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200201193
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TOUBER VANG
Title or Position: PRESIDENT
Credential: MD
Phone: 910-572-1785