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General NPI Number Information
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NPI Number | 1992037709
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Entity Type | Organization
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Legal Business Name | PACK FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 212 S PINE ST
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-9163
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Country | US
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Telephone | 910-862-7225
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Fax |
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Provider Business Mailing Address
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Address Line | 212 S PINE ST
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-9163
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Country | US
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Telephone | 910-862-7225
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MS. KAREN B PACK
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Credential | PA-C
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Telephone | 910-862-7225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 101844
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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