| Sw Durham Family Medicine | |
|
1515 W Nc Hwy 54 Ste 130 Durham NC 27707 | |
| (919) 419-0242 | |
| (919) 401-4172 |
| Full Name | Sw Durham Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1515 W Nc Hwy 54, Durham, North Carolina |
| Authorized Official Name and Position | Tiffany Marum (MANAGING PHYSICIAN) |
| Authorized Official Contact | 9194190242 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sw Durham Family Medicine 1515 W Nc Hwy 54 Ste 130 Durham NC 27707 Ph: (919) 419-0242 | Sw Durham Family Medicine 1515 W Nc Hwy 54 Ste 130 Durham NC 27707 Ph: (919) 419-0242 |
| NPI Number | 1295706133 |
|---|---|
| Provider Enumeration Date | 01/30/2006 |
| Last Update Date | 09/21/2022 |
| Medicare PECOS PAC ID | 5294792248 |
|---|---|
| Medicare Enrollment ID | O20041213000018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295706133 | NPI | - | NPPES |
| 017RT | Other | NC | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 200300258 (North Carolina) | Primary |
| 207R00000X | Internal Medicine | 9700021 (North Carolina) | Secondary |
| Provider Name | Tiffany Marum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548466204 PECOS PAC ID: 5597721159 Enrollment ID: I20041206000325 |
| Provider Name | Hana Aous Alkhaldi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295041937 PECOS PAC ID: 4486892155 Enrollment ID: I20150626000272 |
| Provider Name | Katherine Kulenic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083918841 PECOS PAC ID: 0042519779 Enrollment ID: I20160502002447 |
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