Raleigh Family Practice Pa | |
4414 Lake Boone Trl Suite 502 Raleigh NC 27607-7513 | |
(919) 875-0539 | |
(919) 875-1051 |
Full Name | Raleigh Family Practice Pa |
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Speciality | Family Medicine |
Location | 4414 Lake Boone Trl, Raleigh, North Carolina |
Authorized Official Name and Position | Kristin T Fisher (PRACTICE ADMINISTRATOR) |
Authorized Official Contact | 9198750539 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Raleigh Family Practice Pa 4414 Lake Boone Trl Suite 502 Raleigh NC 27607-7513 Ph: (919) 875-0539 | Raleigh Family Practice Pa 4414 Lake Boone Trl Suite 502 Raleigh NC 27607-7513 Ph: (919) 875-0539 |
NPI Number | 1063571040 |
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Provider Enumeration Date | 12/06/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 0840292637 |
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Medicare Enrollment ID | O20070207000431 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063571040 | NPI | - | NPPES |
7901842 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 84061 (North Carolina) | Primary |
Provider Name | Jaimita V Patel |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1851442677 PECOS PAC ID: 0042316739 Enrollment ID: I20070425000606 |
Provider Name | Gary Owen Bean |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1760452312 PECOS PAC ID: 7113119280 Enrollment ID: I20101007000540 |
Provider Name | Andrew Carl Babcock |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1023219276 PECOS PAC ID: 8628259082 Enrollment ID: I20110218000457 |
Provider Name | Aaron David Jarrett |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1689017394 PECOS PAC ID: 1658514054 Enrollment ID: I20200721001362 |
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