| Fleetwood Family Medicine | |
|
13300-13290 Hwy 221 S Fleetwood NC 28626-0178 | |
| (336) 877-9090 | |
| (336) 877-8880 |
| Full Name | Fleetwood Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 13300-13290 Hwy 221 S, Fleetwood, North Carolina |
| Authorized Official Name and Position | Charles Wright (CFO) |
| Authorized Official Contact | 3368460798 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fleetwood Family Medicine 200 Hospital Ave Jefferson NC 28640-9244 Ph: (336) 846-0704 | Fleetwood Family Medicine 13300-13290 Hwy 221 S Fleetwood NC 28626-0178 Ph: (336) 877-9090 |
| NPI Number | 1639757974 |
|---|---|
| Provider Enumeration Date | 03/30/2021 |
| Last Update Date | 04/01/2021 |
| Medicare PECOS PAC ID | 7315912870 |
|---|---|
| Medicare Enrollment ID | O20210624001001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639757974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Suzanne M Paszkowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275550113 PECOS PAC ID: 7012018088 Enrollment ID: I20130604000654 |
| Provider Name | Kathleen G Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487022372 PECOS PAC ID: 0446532022 Enrollment ID: I20181129000811 |
| Provider Name | Tara Blalock Burgher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588814131 PECOS PAC ID: 8325355274 Enrollment ID: I20200506000480 |
| Provider Name | Tracie L Henson-combs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942882477 PECOS PAC ID: 3779971668 Enrollment ID: I20211026002103 |
| Provider Name | Raegan Mcneil Church |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194324756 PECOS PAC ID: 5698166197 Enrollment ID: I20211216001819 |