Provider Demographics
NPI:1265752364
Name:VILLAGE FAMILY PRACTICE OF HOLLY SPRINGS PLLC
Entity type:Organization
Organization Name:VILLAGE FAMILY PRACTICE OF HOLLY SPRINGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:GALLUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-577-6900
Mailing Address - Street 1:351 W. CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-5902
Mailing Address - Country:US
Mailing Address - Phone:919-577-6900
Mailing Address - Fax:919-577-2008
Practice Address - Street 1:351 W. CENTER STREET
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-5902
Practice Address - Country:US
Practice Address - Phone:919-577-6900
Practice Address - Fax:919-577-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty