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General NPI Number Information
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NPI Number | 1508850587
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Entity Type | Organization
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Legal Business Name | WEST COLUMBUS FAMILY PRACTICE PA
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 110 N BROWN ST
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City | CHADBOURN
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State | NC
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Zip | 28431-1702
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Country | US
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Telephone | 910-654-1701
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Fax | 910-654-5701
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Provider Business Mailing Address
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Address Line | PO BOX 325
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City | CHADBOURN
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State | NC
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Zip | 28431-0325
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Country | US
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Telephone | 910-654-1701
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Fax | 910-654-5701
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Authorized Official
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Title or Position | CEO OWNER
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Name | MRS. JOYCE BEAVER
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Credential | RN
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Telephone | 910-654-1701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36494
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License Number State | NC
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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 |
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License Number State |
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