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NPI Code Detail

MEDICARE: FAMILY PRACTICE OF SUMMERFIELD PLLC

MEDICARE: FAMILY PRACTICE OF SUMMERFIELD PLLC
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
1207Q00000XFamily Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number : 1134106032
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY PRACTICE OF SUMMERFIELD PLLC
Provider Business Mailing Address
First Line : PO BOX 220
Second Line :
City : SUMMERFIELD
State : NC
Zip : 27358-0220
Country : US
Telephone Number : 336-643-7711
Fax Number : 336-643-3047
Provider Business Practice Location Address
First Line : 4431 HIGHWAY 220 NORTH
Second Line :
City : SUMMERFIELD
State : NC
Zip : 27358-9411
Country : US
Telephone Number : 336-643-7711
Fax Number : 336-643-3047
Authorized Official
Title or Position : MANAGING PARTNER
Name : BRENT A BURNETT
Credential : MD
Telephone Number : 336-643-7711
Provider Enumeration Date : 12/30/2005
Last Update Date : 04/28/2008

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Directions to “FAMILY PRACTICE OF SUMMERFIELD PLLC ” Practice Location

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