NPIMap

Organization Active NPI

Knightdale Family Practice

  • Non-Pharmacy Dispensing Site
  • Knightdale, NC
National Provider Identifier
1689804403
Registry record updated Jul 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
9401111 Issued in NC
Legal business name
KNIGHTDALE FAMILY PRACTICE
Practice address
6905 Knightdale Blvd
Suite 106
Knightdale, NC 27545-6505
Phone
(919) 266-6211
NPI assigned
Jul 15, 2009
Last updated
Jul 15, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 15, 2009

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 9401111 NC Primary

Addresses

Primary practice location

6905 Knightdale Blvd
Suite 106
Knightdale, NC 27545-6505

Mailing address

5810 Nancy Ridge Dr
100
San Diego, CA 92121-2834

National Provider Directory

National Provider Directory
Tax ID family
McCrimmon Primary Care Plus66 organizations share this tax ID, including this one
Part of
Medvantx Inc

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

5810 Nancy Ridge Dr
Ste 100
San Diego, CA 92121
Phone (858) 625-2990

NPI Registry JSON

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

{
    "created_epoch": "1247616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247616000000",
    "number": "1689804403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5810 NANCY RIDGE DR",
            "address_2": "100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6905 KNIGHTDALE BLVD",
            "address_2": "SUITE 106",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275456505",
            "telephone_number": "919-266-6211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNIGHTDALE FAMILY PRACTICE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2009-07-15",
        "last_updated": "2009-07-15",
        "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": "9401111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knightdale, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.