NPIMap

Organization Active NPI

Ashe Memorial Hospital Inc

Doing business as Fleetwood Family Medicine

  • Family Medicine Physician
  • Fleetwood, NC
National Provider Identifier
1639757974
Registry record updated Apr 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ASHE MEMORIAL HOSPITAL INC
Doing business as
Fleetwood Family Medicine
Practice address
13300-13290 Hwy 221 S
Fleetwood, NC 28626-0178
Phone
(336) 877-9090
Fax
(336) 877-8880
NPI assigned
Mar 30, 2021
Last updated
Apr 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

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

Authorized official

Name
Charles Wright
Title
Cfo
Phone
(336) 846-0798

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

13300-13290 Hwy 221 S
Fleetwood, NC 28626-0178

Mailing address

200 Hospital Ave
Jefferson, NC 28640-9244
Phone (336) 846-0704

Other names 1

  • FLEETWOOD FAMILY MEDICINE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210624001001 NC Part B Supplier - Clinic/Group Practice 7315912870 Receives reassigned benefits from 5 practitioners
Practice locations: Fleetwood, NC

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2223248Fleetwood Family Medicine13300-13290 Hwy 221 South, Fleetwood, NC 28626Certificate of waiverMay 4, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Amh Mountain Family Care CenterJefferson, NC, CCN 343425 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2003

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617235200000",
    "number": "1639757974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL AVE",
            "city": "JEFFERSON",
            "state": "NC",
            "postal_code": "286409244",
            "telephone_number": "336-846-0704",
            "fax_number": "336-846-0758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13300-13290 HWY 221 S",
            "city": "FLEETWOOD",
            "state": "NC",
            "postal_code": "286260178",
            "telephone_number": "336-877-9090",
            "fax_number": "336-877-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASHE MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-30",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "336-846-0798"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FLEETWOOD FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FLEETWOOD FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fleetwood, NC

Sources for this page

Verify at the official NPI Registry.