Carolina Family Clinic PA
Organization Active NPI Family Medicine Physician · Laurinburg, NC
NPI 1780109603 · NPPES record last updated Jun 11, 2020
Key facts
- NPI
- 1780109603
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CAROLINA FAMILY CLINIC PA
- Practice address
- 1707 Berwick Dr Ste B
Laurinburg, NC 28352-5543 - Phone
- (910) 276-1150
- NPI assigned
- Aug 11, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Allen James Ballew, DO
- Title
- Owner
- Phone
- (910) 276-1150
Practitioners 5
-
Allen J Ballew, DO
-
Marc Sciarra, D.O.
-
Sisi Liang, DPM
-
Glenn Ray Harris, MD
-
John W. Neal, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2146956 | Carolina Family Clinic, PA | Provider-performed microscopy | Apr 9, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171017002621 | NC | Part B Supplier - Clinic/Group Practice | 1052687159 |
Receives reassigned benefits from 2 practitioners Practice locations: Laurinburg, NC |
National Provider Directory
Locations
1707 Berwick Dr
Ste B
Laurinburg, NC 28352
519 Lauchwood Dr
Laurinburg, NC 28352
Phone (910) 276-1150
1707 Berwick Dr
Ste B
Laurinburg, NC 28352
Phone (215) 651-8863
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1707 Berwick Dr Ste B
Laurinburg, NC 28352-5543
Mailing address
1048 Terrace Dr
Marion, VA 24354-4138
Phone (276) 783-1827
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2016-02469 | Other | NC | NORTH CAROLINA MEDICAL BOARD |
Other providers in Laurinburg, NC
- Shemeka L Campbell
- Cardinal Clinic LLC
- Carenet, Inc.
- Carolina Diagnostics, Inc.
- Carolina Eye Associates Inc
- Carolina Family Foot and Ankle
- Carolina Hearts Home Care, LLC
- Carolina Hearts Home Care, LLC
- Carolina Hearts Home Care, LLC
- Carolina Medical Clinic PLLC
All providers in Laurinburg, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.