Provider Demographics
NPI:1447251103
Name:TABOR CITY FAMILY MEDICINE CENTER, INC.
Entity type:Organization
Organization Name:TABOR CITY FAMILY MEDICINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS. REP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-756-5300
Mailing Address - Street 1:3439 CASEY ST
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-2903
Mailing Address - Country:US
Mailing Address - Phone:843-756-5300
Mailing Address - Fax:843-756-6059
Practice Address - Street 1:909 PIREWAY RD
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463-8942
Practice Address - Country:US
Practice Address - Phone:910-653-2112
Practice Address - Fax:910-653-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1447251103OtherNPI
NC02787OtherBCBS OF NC
NC343916AMedicaid
NCCA9980OtherRAILROAD MEDICARE
SCE03PA0OtherMEDICAID FOR SOUTH CAROLINA
NC0363OtherCIGNA MEDICARE GOV'T SVCS
SCE03PA0OtherMEDICAID FOR SOUTH CAROLINA
NC0363OtherCIGNA MEDICARE GOV'T SVCS