NPIMap

Organization Active NPI

Family Wellness Clinic

  • Health Service Clinic/Center
  • Clayton, NC
National Provider Identifier
1952799892
Registry record updated Dec 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
200400430 Issued in NC
Legal business name
FAMILY WELLNESS CLINIC
Practice address
2076 NC Highway 42 W Ste 230
Clayton, NC 27520-5303
Phone
(919) 553-5711
Fax
(919) 553-5712
NPI assigned
Dec 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2014

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

Authorized official

Name
Dr. Bhavna Vaidya Tank, M.D.
Title
Owner
Phone
(919) 553-5711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 200400430 NC Primary

Addresses

Primary practice location

2076 NC Highway 42 W Ste 230
Clayton, NC 27520-5303

Mailing address

2076 NC Highway 42 W Ste 230
Clayton, NC 27520-5303
Phone (919) 553-5711

Other identifiers 1

IdentifierTypeStateIssuer
CA891372VMedicaidNC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1419897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419897600000",
    "number": "1952799892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2076 NC HIGHWAY 42 W STE 230",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275205303",
            "telephone_number": "919-553-5711",
            "fax_number": "919-553-5712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2076 NC HIGHWAY 42 W STE 230",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275205303",
            "telephone_number": "919-553-5711",
            "fax_number": "919-553-5712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-30",
        "last_updated": "2014-12-30",
        "status": "A",
        "authorized_official_last_name": "TANK",
        "authorized_official_first_name": "BHAVNA",
        "authorized_official_middle_name": "VAIDYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-553-5711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NC",
            "license": "200400430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CA891372V",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; 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.