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CLUB HAVEN FAMILY PRACTICE
NPI 1902869829
Specialist in Winston-salem, NC

Active since April 11, 2006
2801 LYNDHURST AVE, WINSTON-SALEM, NC 27103(336) 768-9575(336) 774-1737 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: September 27, 2026.

About Club Haven Family Practice NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLUB HAVEN FAMILY PRACTICE (NPI 1902869829) is a healthcare organization registered as a specialist in Winston-salem, North Carolina and active in the NPI registry since April 2006. The organization lists Thomas L. Jolly, Owner, as its authorized official.

NPPES Registry Identity

NPI1902869829
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameCLUB HAVEN FAMILY PRACTICE
Location Address2801 LYNDHURST AVEWinston-salem, NC 27103-4109
Mailing Address2801 Lyndhurst AveWinston-salem, NC 27103-4109 · (336) 768-9575 · Fax (336) 774-1737
Phone(336) 768-9575
Fax(336) 774-1737
Organization SubpartNo
Authorized OfficialThomas L. JollyOwner · (336) 768-9575
Enumeration DateApril 11, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1902869829 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in NC · 40378/30659
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
2801 LYNDHURST AVE, Winston-salem, NC 27103
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Other Identifiers 1

Other01602NC · Bcbs Of Nc

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CLUB HAVEN FAMILY PRACTICE PA
Family Medicine
2801 LYNDHURST AVE
WINSTON SALEM, NC 27103
Forsyth County (336) 768-9575
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Family Medicine
2801 LYNDHURST AVE
WINSTON SALEM, NC 27103
Forsyth County (336) 768-9575

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Club Haven Family Practice's NPI number?

The NPI number for Club Haven Family Practice is 1902869829. It was assigned to this organization in the NPPES registry on April 11, 2006.

Where is Club Haven Family Practice located?

Club Haven Family Practice is located at 2801 Lyndhurst Ave, Winston-Salem, NC 27103. The listed phone number is (336) 768-9575.

What is Club Haven Family Practice's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Club Haven Family Practice was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.