NPIMap

Organization Active NPI

Carolina Family Medicine & Urgent Care PA

  • Internal Medicine Physician
  • Statesville, NC
National Provider Identifier
1740499714
Registry record updated Jun 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
200001772371 Issued in NC
Legal business name
CAROLINA FAMILY MEDICINE & URGENT CARE PA
Practice address
1503 E Broad St
Statesville, NC 28625-4301
Phone
(704) 871-9731
Fax
(704) 871-1105
NPI assigned
May 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2012

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

Authorized official

Name
Mrs. Codey Jean Brown
Title
Office Manager/Delegated Official
Phone
(704) 871-9731

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 200001772371 NC Primary

Addresses

Primary practice location

1503 E Broad St
Statesville, NC 28625-4301

Mailing address

1503 E Broad St
Statesville, NC 28625-4301
Phone (704) 871-9731

Other identifiers 2

IdentifierTypeStateIssuer
89014W8MedicaidNC
014W8OtherNCBCBSNC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340668800000",
    "number": "1740499714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 E BROAD ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254301",
            "telephone_number": "704-871-9731",
            "fax_number": "704-871-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 E BROAD ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254301",
            "telephone_number": "704-871-9731",
            "fax_number": "704-871-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA FAMILY MEDICINE & URGENT CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2012-06-26",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "CODEY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OFFICE MANAGER/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "704-871-9731",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "200001772371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89014W8",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "014W8",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.