| Tall Oaks Family Practice | |
|
798 Oak Ridge Farm Rd. Suite A Mooresville NC 28115 | |
| (704) 658-0011 | |
| (704) 658-0012 |
| Full Name | Tall Oaks Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 798 Oak Ridge Farm Rd., Mooresville, North Carolina |
| Authorized Official Name and Position | Kevin B Vanhoy (OWNER, PROVIDER) |
| Authorized Official Contact | 7046580011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tall Oaks Family Practice 798 Oak Ridge Farm Rd. Suite A Mooresville NC 28115 Ph: (704) 658-0011 | Tall Oaks Family Practice 798 Oak Ridge Farm Rd. Suite A Mooresville NC 28115 Ph: (704) 658-0011 |
| NPI Number | 1235198482 |
|---|---|
| Provider Enumeration Date | 03/17/2006 |
| Last Update Date | 05/04/2010 |
| Medicare PECOS PAC ID | 9234020421 |
|---|---|
| Medicare Enrollment ID | O20040324001653 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235198482 | NPI | - | NPPES |
| 891108X | Medicaid | NC | |
| 012NE | Other | NC | BCBS ID# |
| 89012NE | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 101555 (North Carolina) | Primary |
| Provider Name | Ronald C Huffman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730182957 PECOS PAC ID: 4688666332 Enrollment ID: I20040401000821 |
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