# JACKSONVILLE FAMILY MEDICAL CENTER, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104925056
- **Authorized official:** DR. RICKY A THOMAS M.D. (PHYSICIAN)
- **Authorized official phone:** (910) 938-3200

## Contact information

- **Practice address:** 2587 HENDERSON DR, JACKSONVILLE, NC 28546-5253
- **Practice address phone:** (910) 938-3200
- **Practice address fax:** (910) 938-3043
- **Mailing address:** 2587 HENDERSON DR, JACKSONVILLE, NC 28546-5253
- **Mailing address phone:** (910) 938-3200
- **Mailing address fax:** (910) 938-3043

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 36058 | NC | Yes |

## Other

- **Enumeration date:** 09/21/2006
- **Last updated:** 05/09/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 89011JH | — | NC |
| 01 | — | DG9898 | RAILROAD MEDICARE PIN | NC |