NPIMap

Organization Active NPI

Roxboro Family Medicine & Immediate

  • Family Medicine Physician
  • Roxboro, NC
National Provider Identifier
1619908233
Registry record updated Jun 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ROXBORO FAMILY MEDICINE & IMMEDIATE
Practice address
228 S Madison Blvd
Roxboro, NC 27573-5428
Phone
(336) 598-5480
Fax
(336) 598-5482
NPI assigned
Jul 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2009

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

Authorized official

Name
Lisa P Shock, PA
Title
President
Phone
(336) 598-5480

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

228 S Madison Blvd
Roxboro, NC 27573-5428

Mailing address

PO Box 61474
Durham, NC 27715-1474
Phone (919) 544-6318

Other identifiers 2

IdentifierTypeStateIssuer
014M1OtherNCBCBS-NC GROUP NO
5903189MedicaidNC

National Provider Directory

National Provider Directory

Locations

228 S Madison Blvd
Roxboro, NC 27573
Phone (336) 598-5480

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244592000000",
    "number": "1619908233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 61474",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277151474",
            "telephone_number": "919-544-6318",
            "fax_number": "919-544-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 S MADISON BLVD",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275735428",
            "telephone_number": "336-598-5480",
            "fax_number": "336-598-5482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROXBORO FAMILY MEDICINE & IMMEDIATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2009-06-10",
        "status": "A",
        "authorized_official_last_name": "SHOCK",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-598-5480",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-NC GROUP NO",
            "identifier": "014M1",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903189",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roxboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; 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.