Look up the most recent NPI and PECOS records

Fayetteville Area Health Education Foundation Inc

(<Unavail>)

Family Medicine

Allopathic & Osteopathic Physicians

1601 Owen Dr, Fayetteville, NC 28304-3425

PECOS Enrollment

Based on the most recent information from CMS, provider Fayetteville Area Health Education Foundation Inc 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
1811072812
Provider Type
Organization
Full Name
Fayetteville Area Health Education Foundation Inc
Other Name
<Unavail>

Subpart
No
Enumeration Date
10/26/2006
Last Updated
10/25/2019

Contact Information

Practice Location

1601 Owen Dr, Fayetteville, NC 28304-3425

(910) 678-0100

(910) 678-0115

Mailing Location

1601 Owen Dr, Fayetteville, NC 28304-3425

(910) 678-0100

(910) 678-0115

Authorized Official

Kapoor, Sushma Surrinder (President & Ceo)

(910) 678-7230

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 103T00000X	Description Psychologist Behavioral Health & Social Service Providers	License Unlisted Issuer
Code 207RE0101X	Description Internal Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207RI0200X	Description Internal Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208000000X	Description Pediatrics Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 2080P0202X	Description Pediatrics Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 2080P0205X	Description Pediatrics Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 2084P0800X	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 8903078	Description Medicaid	Issuer Unlisted North Carolina

Fayetteville Area Health Education Foundation Inc

(<Unavail>)

PECOS Enrollment

Profile Details

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