NPIMap

Organization Active NPI

Raleigh Family Practice, P.a.

  • Non-Pharmacy Dispensing Site
  • Raleigh, NC
National Provider Identifier
1255592283
Registry record updated Oct 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
23998 Issued in NC
Legal business name
RALEIGH FAMILY PRACTICE, P.A.
Practice address
4414 Lake Boone TRL
502
Raleigh, NC 27607-7513
Phone
(919) 875-0539
NPI assigned
Jun 23, 2008
Last updated
Oct 22, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 22, 2012

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

Authorized official

Name
Kenny Heine
Title
Director of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 23998 NC Primary

Addresses

Primary practice location

4414 Lake Boone TRL
502
Raleigh, NC 27607-7513

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

National Provider Directory

National Provider Directory
Part of
Hamot Health Foundation

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1255592283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4414 LAKE BOONE TRL",
            "address_2": "502",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077513",
            "telephone_number": "919-875-0539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEIGH FAMILY PRACTICE, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX INC",
        "enumeration_date": "2008-06-23",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NC",
            "license": "23998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; 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.