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Organization
NORTH CAROLINA REGIONAL NETWORK
Active
Organization
NORTH CAROLINA REGIONAL NETWORK
Active
Other names
Rutherford Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MARK AYCOCK (EXECUTIVE VICE PRESIDENT)
(864) 560-6000
Entity
Organization
Contact information
Practice address
444 NC HIGHWAY 108, RUTHERFORDTON, NC 28139-7871
(828) 286-2302
(828) 287-4320
Mailing address
PO BOX 2168, SPARTANBURG, SC 29304-2168
(864) 560-4304
(864) 560-4413
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
05
—
2343808
—
NC
05
—
790250Y
—
NC
01
—
CK6810
RAIL ROAD MEDICARE
NC
01
—
CN1627
RR MEDICARE
SC
Enumeration date
10/24/2006
Last updated
08/24/2011
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