MEDICARE: CHADBOURN FAMILY PRACTICE CENTER PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	363L00000X	Nurse Practitioner
3	363LF0000X	Family Nurse Practitioner
4	261QR1300X	Rural Health Clinic/Center

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780643999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHADBOURN FAMILY PRACTICE CENTER PA

Provider Business Mailing Address
First Line	:	104 E 7TH AVE
Second Line	:
City	:	CHADBOURN
State	:	NC
Zip	:	28431-1402
Country	:	US
Telephone Number	:	910-654-3143
Fax Number	:	910-654-4144

Provider Business Practice Location Address
First Line	:	104 E 7TH AVE
Second Line	:
City	:	CHADBOURN
State	:	NC
Zip	:	28431-1402
Country	:	US
Telephone Number	:	910-654-3143
Fax Number	:	910-654-4144

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	DOLLIE ELKINS
Credential	:
Telephone Number	:	910-654-3143

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	09/06/2023

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