Provider Demographics
NPI:1548828965
Name:TABOR CITY FAMILY MEDICAL CLINIC, PC
Entity type:Organization
Organization Name:TABOR CITY FAMILY MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEKING
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:910-377-8002
Mailing Address - Street 1:706 E 5TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:TABOR CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28463-2335
Mailing Address - Country:US
Mailing Address - Phone:910-377-8002
Mailing Address - Fax:910-377-8032
Practice Address - Street 1:706 E 5TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463-2335
Practice Address - Country:US
Practice Address - Phone:910-207-3697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TABOR CITY FAMILY MEDICAL CLINIC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-31
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty