# NORTH CAROLINA REGIONAL NETWORK

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Rutherford Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740363449
- **Authorized official:** MARK AYCOCK (EXECUTIVE VICE PRESIDENT)
- **Authorized official phone:** (864) 560-6000

## Contact information

- **Practice address:** 444 NC HIGHWAY 108, RUTHERFORDTON, NC 28139-7871
- **Practice address phone:** (828) 286-2302
- **Practice address fax:** (828) 287-4320
- **Mailing address:** PO BOX 2168, SPARTANBURG, SC 29304-2168
- **Mailing address phone:** (864) 560-4304
- **Mailing address fax:** (864) 560-4413

## Taxonomy

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

## Other

- **Enumeration date:** 10/24/2006
- **Last updated:** 08/24/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2343808 | — | NC |
| 05 | — | 790250Y | — | NC |
| 01 | — | CK6810 | RAIL ROAD MEDICARE | NC |
| 01 | — | CN1627 | RR MEDICARE | SC |