Organization
CHRISTOPHERSON FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS F LAYMON (SR. VICE PRESIDENT)
(704) 403-2276
Entity
Organization
Contact information
Practice address
319 PENNY LN, CONCORD, NC 28025-1221
(704) 403-2680
(704) 784-4346
Mailing address
319 PENNY LN, CONCORD, NC 28025-1221
(704) 403-2680
(704) 784-4346
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34832
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011JE
BCBS NC OLD GROUP#
NC
01
—
5905765
MEDICAID OLD GROUP NUMBER
NC
05
—
5906984
—
NC
01
—
892247A
MEDICAID OLD GROUP NUMBER
NC
01
—
DF5941
RAILROAD MEDICARE PTAN, GROUP
NC
Enumeration date
01/16/2007
Last updated
02/22/2016
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