| Old Town Family Medicine, P A | |
|
3690 Reynolda Rd Winston Salem NC 27106-2230 | |
| (336) 922-1363 | |
| Not Available |
| Full Name | Old Town Family Medicine, P A |
|---|---|
| Speciality | Clinic/center |
| Location | 3690 Reynolda Rd, Winston Salem, North Carolina |
| Authorized Official Name and Position | Richard Ray Herber (PRESIDENT) |
| Authorized Official Contact | 3369221363 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Town Family Medicine, P A 3690 Reynolda Rd Winston Salem NC 27106-2230 Ph: (336) 922-1363 | Old Town Family Medicine, P A 3690 Reynolda Rd Winston Salem NC 27106-2230 Ph: (336) 922-1363 |
| NPI Number | 1447370101 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 01/26/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447370101 | NPI | - | NPPES |
| 8941873 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 39614 (North Carolina) | Primary |
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