# FAMILY MEDICAL CARE OF ROWAN PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Nickerson Family Medical Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528045390
- **Authorized official:** LLOYD EMERY NICKERSON MD (OWNER MEDICAL DOCTOR)
- **Authorized official phone:** (704) 633-7070

## Contact information

- **Practice address:** 300 N SALISBURY AVE, SPENCER, NC 28159-2514
- **Practice address phone:** (704) 633-7070
- **Practice address fax:** (704) 633-7627
- **Mailing address:** 300 N SALISBURY AVE, SPENCER, NC 28159-2514
- **Mailing address phone:** (704) 633-7070
- **Mailing address fax:** (704) 633-7627

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/22/2005
- **Last updated:** 06/06/2008

## 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 |