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General NPI Number Information
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NPI Number | 1245218940
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Entity Type | Organization
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Legal Business Name | BETHLEHEM FAMILY PRACTICE, PA
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 174 BOLICK LN SUITE 202
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City | TAYLORSVILLE
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State | NC
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Zip | 28681-3319
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Country | US
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Telephone | 828-495-8226
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Fax | 828-495-4191
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Provider Business Mailing Address
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Address Line | PO BOX 6306 BETHLEHEM STATION
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City | HICKORY
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State | NC
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Zip | 28603-6403
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Country | US
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Telephone | 828-495-8226
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Fax | 828-495-4191
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | MARK A FARUQUE
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Credential | MD
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Telephone | 828-495-8226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 33651
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License Number State | NC
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