| House Of Life Family Practice Pllc | |
|
1800 S Hawthorne Rd Winston Salem NC 27103-4014 | |
| (336) 765-3430 | |
| (336) 765-3429 |
| Full Name | House Of Life Family Practice Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1800 S Hawthorne Rd, Winston Salem, North Carolina |
| Authorized Official Name and Position | Michele Denise Powell (MEMBER/MANAGER) |
| Authorized Official Contact | 3367653430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| House Of Life Family Practice Pllc 1800 S Hawthorne Rd Winston Salem NC 27103-4014 Ph: (336) 765-3430 | House Of Life Family Practice Pllc 1800 S Hawthorne Rd Winston Salem NC 27103-4014 Ph: (336) 765-3430 |
| NPI Number | 1659349041 |
|---|---|
| Provider Enumeration Date | 03/10/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 6204840457 |
|---|---|
| Medicare Enrollment ID | O20060126001013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659349041 | NPI | - | NPPES |
| 89131Y7 | Medicaid | NC | |
| 131Y7 | Other | BLUE CROSS BS | |
| 1033392774 | Other | NC | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (North Carolina) | Primary |
| Provider Name | Michele D Powell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033392774 PECOS PAC ID: 8123057452 Enrollment ID: I20050808000479 |
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