Provider Demographics
NPI:1831414150
Name:ISLAND FAMILY MEDICINE, PLLC
Entity type:Organization
Organization Name:ISLAND FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:910-329-9916
Mailing Address - Street 1:P.O BOX 2400
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445-2400
Mailing Address - Country:US
Mailing Address - Phone:910-329-9916
Mailing Address - Fax:910-329-9919
Practice Address - Street 1:2540 NC HIGHWAY 210 E
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-8988
Practice Address - Country:US
Practice Address - Phone:910-329-9916
Practice Address - Fax:910-329-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE55731Medicare UPIN