MEDICARE: FAMILY CARE HEALTH AND WELLNESS CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114921137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE HEALTH AND WELLNESS CENTER, INC.

Provider Business Mailing Address
First Line	:	1430 HSA LN
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27101-2048
Country	:	US
Telephone Number	:	336-723-9002
Fax Number	:	336-722-3780

Provider Business Practice Location Address
First Line	:	1430 HSA LN
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27101-2048
Country	:	US
Telephone Number	:	336-723-9002
Fax Number	:	336-722-3780

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. SANDRA LEIGH SMITH
Credential	:
Telephone Number	:	336-723-9002

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/28/2008

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