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General NPI Number Information
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NPI Number | 1780645812
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Entity Type | Organization
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Legal Business Name | SISTASIS FAMILY PRACTICE,INC.
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 147 E ACADEMY ST
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City | ASHEBORO
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State | NC
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Zip | 27203-5706
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Country | US
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Telephone | 336-633-1212
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Fax | 336-633-1218
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Provider Business Mailing Address
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Address Line | PO BOX 4247
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City | ASHEBORO
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State | NC
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Zip | 27204-4247
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Country | US
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Telephone | 336-633-1212
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Fax | 336-633-1218
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. ROWENA SISTASIS
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Credential | MD
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Telephone | 336-633-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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