Provider Demographics
NPI:1578638078
Name:PITT FAMILY PHYSICIANS, PA
Entity type:Organization
Organization Name:PITT FAMILY PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MADISON
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:252-746-3116
Mailing Address - Street 1:137 3RD ST
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-7252
Mailing Address - Country:US
Mailing Address - Phone:252-746-3116
Mailing Address - Fax:252-746-2394
Practice Address - Street 1:137 3RD ST
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-7252
Practice Address - Country:US
Practice Address - Phone:252-746-3116
Practice Address - Fax:252-746-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02398OtherBLUE CROSS BLUE SHIELD
NC8902398Medicaid
NCCD1753OtherRAILROAD MEDICARE
NC230167Medicare PIN