Holly Springs Family Practice
Organization Active NPI Family Medicine Physician · Pilot Mountain, NC
NPI 1346353869 · NPPES record last updated Jun 21, 2018
Key facts
- NPI
- 1346353869
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- HOLLY SPRINGS FAMILY PRACTICE
- Practice address
- 104 Ararat Long Hill Rd
Pilot Mountain, NC 27041-8113 - Phone
- (336) 786-7966
- Fax
- (336) 786-1601
- NPI assigned
- Aug 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Randall S Keith, MD
- Title
- Medical Doctor
- Phone
- (336) 786-7966
Practitioners 1
-
Randall Scott Keith, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0972771 | Holly Springs Family Practice | Certificate of waiver | Jul 23, 2027 |
National Provider Directory
Locations
104 Ararat Longhill Rd
Pilot Mtn, NC 27041
Phone (336) 786-7966
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
104 Ararat Long Hill Rd
Pilot Mountain, NC 27041-8113
Mailing address
104 Ararat Long Hill Rd
Pilot Mountain, NC 27041-8113
Phone (336) 786-7966
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8948063 | Medicaid | NC |
Other providers in Pilot Mountain, NC
- Forsyth Memorial Hospital Inc
- Donna Goins
- Harrison Therapy, PLLC
- Michelle Hiatt
- Lee Ann Holland
- Stephanie Cheryl Johnson
- Samantha Smith Joyce
- Randall Scott Keith
- Kent N. Tucker,D.D.S.,P.a.
- Kidscan Therapy Services
All providers in Pilot Mountain, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.