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Organization
FAMILY MEDICAL CARE OF ROWAN PA
Active
Organization
FAMILY MEDICAL CARE OF ROWAN PA
Active
Other names
Nickerson Family Medical Care
Organization subpart
No
Provider details
NPI number
Authorized official
LLOYD EMERY NICKERSON MD (OWNER MEDICAL DOCTOR)
(704) 633-7070
Entity
Organization
Contact information
Practice address
300 N SALISBURY AVE, SPENCER, NC 28159-2514
(704) 633-7070
(704) 633-7627
Mailing address
300 N SALISBURY AVE, SPENCER, NC 28159-2514
(704) 633-7070
(704) 633-7627
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0138R
BCBS GROUP ID
—
01
—
202595
BLACK LUNG
—
01
—
500013139
MEDICARE RAILROAD
—
01
—
62644
BCBS PERSONAL ID
—
05
—
890138R
—
NC
01
—
89014CE
MEDICAID
NC
05
—
8962644
—
NC
01
—
970029646
MEDICARE RAILROAD
—
01
—
CL2573
RAILROAD MEDICARE
NC
Enumeration date
12/22/2005
Last updated
06/06/2008
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