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NPI Code Detail

MEDICARE: BREEZEWOOD FAMILY HEALTHCARE, PA

MEDICARE: BREEZEWOOD FAMILY HEALTHCARE, PA
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 Physician116914NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1017EMOTHERNCBCBSNC GROUP NUMBER

General Provider Information

NPI Number : 1356404453
Entity Type Code : Organization
Provider Name (Legal Business Name) : BREEZEWOOD FAMILY HEALTHCARE, PA
Provider Business Mailing Address
First Line : PO BOX 87448
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-7448
Country : US
Telephone Number : 910-485-0700
Fax Number : 910-483-9572
Provider Business Practice Location Address
First Line : 200 FORSYTHE ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-5426
Country : US
Telephone Number : 910-485-0700
Fax Number : 910-483-9572
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. MICHAEL J. JANSEN
Credential :
Telephone Number : 910-485-0700
Provider Enumeration Date : 12/19/2006
Last Update Date : 08/22/2020

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Directions to “BREEZEWOOD FAMILY HEALTHCARE, PA ” Practice Location

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