Fayetteville Family Extended Care

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FAYETTEVILLE FAMILY EXTENDED CARE

Practice address

1307 Avon St
Fayetteville, NC 28304-4423

Phone

(910) 323-1718

Fax

(910) 323-5701

NPI assigned

Oct 24, 2005

Last updated

Apr 18, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Alice M Kugler

Title

Administrator

Phone

(910) 323-1718

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1710977681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 AVON ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044423",
            "telephone_number": "910-323-1718",
            "fax_number": "910-323-5701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 AVON ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044423",
            "telephone_number": "910-323-1718",
            "fax_number": "910-323-5701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE FAMILY EXTENDED CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "KUGLER",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-323-1718",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "015CY",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89015CY",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.