Look up the most recent NPI and PECOS records

Fayetteville Family Extended Care

Family Medicine

Allopathic & Osteopathic Physicians

1307 Avon St, Fayetteville, NC 28304-4423

PECOS Enrollment

Based on the most recent information from CMS, provider Fayetteville Family Extended Care does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1710977681
Provider Type
Organization
Full Name
Fayetteville Family Extended Care

Subpart
No
Enumeration Date
10/24/2005
Last Updated
4/18/2012

Contact Information

Practice Location

1307 Avon St, Fayetteville, NC 28304-4423

(910) 323-1718

(910) 323-5701

Mailing Location

1307 Avon St, Fayetteville, NC 28304-4423

(910) 323-1718

(910) 323-5701

Authorized Official

Kugler, Alice M (Administrator)

(910) 323-1718

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer North Carolina

Provider Identifiers

ID	Description	Issuer
ID 89015CY	Description Medicaid	Issuer Unlisted North Carolina
ID 015CY	Description Other	Issuer BCBS North Carolina

Fayetteville Family Extended Care

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Precision Health, Pc

Gaskins, Raymond A

Self, Ashley

May, Jessica Parker

Hilbert, Wesley A

Villena, Maria Joanna

Fhpg, Llc

Cumberland County Hospital System Inc

Sangineni, Shireesha

Kapoor, Sushma Surrinder