Organization
BREEZEWOOD FAMILY HEALTHCARE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J. JANSEN (ADMINISTRATOR)
(910) 485-0700
Entity
Organization
Contact information
Practice address
200 FORSYTHE ST, FAYETTEVILLE, NC 28303-5426
(910) 485-0700
(910) 483-9572
Mailing address
PO BOX 87448, FAYETTEVILLE, NC 28304-7448
(910) 485-0700
(910) 483-9572
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
116914
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017EM
BCBSNC GROUP NUMBER
NC
Enumeration date
12/19/2006
Last updated
08/22/2020
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