OrganizationFayetteville Family Medical Care, PaFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1307 Avon St, Fayetteville, NC 28304-4423(910) 323-1718PECOS EnrollmentBased on the most recent information from CMS, provider Fayetteville Family Medical Care, Pa does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1073518536Provider TypeOrganizationFull NameFayetteville Family Medical Care, PaSubpartNoEnumeration Date6/20/2005Last Updated8/19/2015Contact InformationPractice LocationPractice Address1307 Avon St, Fayetteville, NC 28304-4423Phone(910) 323-1718Fax(910) 323-5701Mailing LocationMailing Address1307 Avon St, Fayetteville, NC 28304-4423Phone(910) 323-1718Fax(910) 323-5701Authorized OfficialNameKugler, Alice M (Administrator)Phone(910) 323-1718Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID8901559DescriptionMedicaidIssuerUnlistedNorth CarolinaID3442124DescriptionOtherIssuerNCPDP PROVIDER IDENTIFICATION NUMBERID01559DescriptionOtherIssuerBCBS