Provider Demographics
NPI:1679586309
Name:CLIMAX FAMILY PRACTICE PA
Entity type:Organization
Organization Name:CLIMAX FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-674-8237
Mailing Address - Street 1:1008 NC HIGHWAY 62 E
Mailing Address - Street 2:
Mailing Address - City:CLIMAX
Mailing Address - State:NC
Mailing Address - Zip Code:27233-8094
Mailing Address - Country:US
Mailing Address - Phone:336-674-8237
Mailing Address - Fax:336-674-8968
Practice Address - Street 1:1008 NC HWY 62 EAST
Practice Address - Street 2:
Practice Address - City:CLIMAX
Practice Address - State:NC
Practice Address - Zip Code:27233
Practice Address - Country:US
Practice Address - Phone:336-674-8237
Practice Address - Fax:336-674-8968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7901027Medicaid
NCDG8098OtherRAILROAD MEDICARE
NCDG8098OtherRAILROAD MEDICARE
NC2313575Medicare PIN