Organization · NPI-2

Brunswick Family Medicine PA

Family Medicine · Southport, NC

NPI number1396859872
StatusActive
Last updated in NPPESSep 25, 2014

Details

NPI
1396859872
Entity type
Organization (NPI-2)
Legal business name
Brunswick Family Medicine PA
Organization subpart
No
Enumeration date
Aug 19, 2006
Last updated
Sep 25, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes

Practice location

3960 Executive Park Blvd
Unit 600
Southport, NC 28461

Phone 910-454-4343 · Fax 910-457-9209

Mailing address

3960 Executive Park Blvd
Unit 600
Southport, NC 28461

Phone 910-454-4343 · Fax 910-457-9209

Authorized official

Slade Alan Suchecki
President
9104544343

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Family Medicine providers in Southport, NC