Organization
FAYETTEVILLE FAMILY EXTENDED CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALICE M KUGLER (ADMINISTRATOR)
(910) 323-1718
Entity
Organization
Contact information
Practice address
1307 AVON ST, FAYETTEVILLE, NC 28304-4423
(910) 323-1718
(910) 323-5701
Mailing address
1307 AVON ST, FAYETTEVILLE, NC 28304-4423
(910) 323-1718
(910) 323-5701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015CY
BCBS
NC
05
—
89015CY
—
NC
Enumeration date
10/24/2005
Last updated
04/18/2012
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