Organization
CEDAR CREEK FAMILY MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY R NIFONG MD (CO OWNER)
(336) 784-0505
Entity
Organization
Contact information
Practice address
11492 OLD US HIGHWAY 52, WINSTON SALEM, NC 27107-9497
(336) 784-0505
(336) 784-0531
Mailing address
5350 S MAIN ST, WINSTON SALEM, NC 27107-9174
(336) 784-0505
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
88463
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014U9
BLUE CROSS BLUE SHIELD
OH
05
—
89014U9
—
NC
Enumeration date
02/13/2008
Last updated
09/10/2024
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