| Tight Lines Family Medicine P.a. | |
|
1902 Meeting Ct Wilmington NC 28401-6631 | |
| (910) 399-7180 | |
| (910) 660-8314 |
| Full Name | Tight Lines Family Medicine P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1902 Meeting Ct, Wilmington, North Carolina |
| Authorized Official Name and Position | Max Brandon Ludlum (OWNER/OPERATOR) |
| Authorized Official Contact | 9105389581 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tight Lines Family Medicine P.a. 1902 Meeting Ct Wilmington NC 28401-6631 Ph: (910) 399-7180 | Tight Lines Family Medicine P.a. 1902 Meeting Ct Wilmington NC 28401-6631 Ph: (910) 399-7180 |
| NPI Number | 1366047748 |
|---|---|
| Provider Enumeration Date | 12/02/2020 |
| Last Update Date | 12/06/2023 |
| Certification Date | 12/06/2023 |
| Medicare PECOS PAC ID | 3577971860 |
|---|---|
| Medicare Enrollment ID | O20210427001054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366047748 | NPI | - | NPPES |
| 1669918223 | Medicaid | NC |
| Provider Name | Patricia A Odham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750457024 PECOS PAC ID: 9234237801 Enrollment ID: I20071109000131 |
| Provider Name | Jennifer Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710337332 PECOS PAC ID: 9739468307 Enrollment ID: I20190522001740 |
| Provider Name | Nicolee Knowles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386110716 PECOS PAC ID: 7719316397 Enrollment ID: I20200402000714 |
| Provider Name | Anne Savarese Depasquale |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730479379 PECOS PAC ID: 2163641655 Enrollment ID: I20210427001215 |
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