Provider Demographics
NPI:1144365115
Name:ALBEMARLE FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:ALBEMARLE FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-335-5424
Mailing Address - Street 1:1141 N ROAD ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3354
Mailing Address - Country:US
Mailing Address - Phone:252-335-5424
Mailing Address - Fax:252-335-9084
Practice Address - Street 1:160C HWY 158
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NC
Practice Address - Zip Code:27921-6908
Practice Address - Country:US
Practice Address - Phone:252-334-9527
Practice Address - Fax:252-334-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905264Medicaid
NC8922603Medicaid
NC012T4OtherBLUE CROSS
NCCJ3847OtherRAILROAD MEDICARE
NC$$$$$$$$$OtherSOCIAL SECURITY
NC5900660Medicaid
NC5900660Medicaid
NCE00450Medicare UPIN
NC156548824OtherSOCIAL SECURITY
NCQ37168Medicare UPIN
NC=========OtherTAX ID
NCF70072Medicare UPIN