MEDICARE: JACKSONVILLE FAMILY MEDICAL CENTER, 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
1	261QF0050X	Non-Surgical Family Planning Clinic/Center	36058	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D75607	OTHER	NC	UPIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205020476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSONVILLE FAMILY MEDICAL CENTER, PLLC

Provider Business Mailing Address
First Line	:	2587 HENDERSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5253
Country	:	US
Telephone Number	:	910-938-3200
Fax Number	:	910-938-3043

Provider Business Practice Location Address
First Line	:	2587 HENDERSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5253
Country	:	US
Telephone Number	:	910-938-3200
Fax Number	:	910-938-3043

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. VERLETA R THOMAS
Credential	:
Telephone Number	:	910-938-3200

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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