Club Haven Family Practice
LBN: Club Haven Family Practice
Club Haven Family Practice is an health care organization with primary practice located at 2801 Lyndhurst Ave , Winston-Salem NC 27103-4109. The organization recently has only one registered license in Other Service Providers / Specialist, which is considered as the primary health care specialty.
Club Haven Family Practice can be contacted via phone (336) 768-9575, or through Jolly, Thomas L. via phone (336) 768-9575.
Contact Information
Primary practice address
2801 Lyndhurst Ave
Winston-Salem NC 27103-4109
Phone: (336) 768-9575
Fax: (336) 774-1737
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 40378/30659 | North Carolina |
Profile Details
| NPI number | 1902869829 |
|---|---|
| LBN Legal business name | Club Haven Family Practice |
| DBA Doing business as | |
| Authorized official | Jolly, Thomas L. MC |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 11th, 2006 |
| Last updated | Aug 22nd, 2020 - about 5 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902869829 | NPPES |
| North Carolina | Other | 01602 | BCBS OF NC |
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