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Organization

NORTH CAROLINA REGIONAL NETWORK

Active
Other names
Rutherford Family Practice
Organization subpart
No

Provider details

NPI number
Authorized official
MARK AYCOCK (EXECUTIVE VICE PRESIDENT)
(864) 560-6000
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2343808
NC
05
790250Y
NC
01
CK6810
RAIL ROAD MEDICARE
NC
01
CN1627
RR MEDICARE
SC
Enumeration date
10/24/2006
Last updated
08/24/2011
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