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General NPI Number Information
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NPI Number | 1497755953
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Entity Type | Organization
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Legal Business Name | MID CAROLINA FAMILY MEDICINE, P.A.
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 1038 ALBEMARLE RD
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City | TROY
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State | NC
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Zip | 27371-8685
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Country | US
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Telephone | 910-572-1785
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Fax | 910-572-1410
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Provider Business Mailing Address
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Address Line | 1038 ALBEMARLE RD
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City | TROY
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State | NC
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Zip | 27371-8684
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Country | US
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Telephone | 910-572-1785
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Fax | 910-572-1410
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TOUBER VANG
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Credential | MD
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Telephone | 910-572-1785
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200201193
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License Number State | NC
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