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Organization
PINE HAVEN FAMILY MEDICINE PA
Active
Organization
PINE HAVEN FAMILY MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN JAMES SLATOSKY JR. DO (OWNER PHYSICIAN)
(336) 498-1200
Entity
Organization
Contact information
Practice address
604 WEST ACADEMY ST, RANDLEMAN, NC 27317
(336) 498-1200
(336) 498-1206
Mailing address
604 WEST ACADEMY ST, RANDLEMAN, NC 27317
(336) 498-1200
(336) 498-1206
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9900682
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2348546
MEDICARE
NC
05
—
891212U
—
NC
Enumeration date
04/28/2008
Last updated
11/30/2012
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