Jacksonville Family Medical Center, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

36058 Issued in NC

Legal business name

JACKSONVILLE FAMILY MEDICAL CENTER, PLLC

Practice address

2587 Henderson Dr
Jacksonville, NC 28546-5253

Phone

(910) 938-3200

Fax

(910) 938-3043

NPI assigned

Sep 21, 2006

Last updated

May 9, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ricky A Thomas, M.D.

Title

Physician

Phone

(910) 938-3200

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1104925056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2587 HENDERSON DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465253",
            "telephone_number": "910-938-3200",
            "fax_number": "910-938-3043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2587 HENDERSON DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465253",
            "telephone_number": "910-938-3200",
            "fax_number": "910-938-3043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE FAMILY MEDICAL CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "RICKY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "910-938-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "36058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "DG9898",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89011JH",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jacksonville Optical Co. Inc.
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• Family Medicine Physician in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.