| Advance Family And Sports Medicine Center, Pllc | |
|
169 Yadkin Valley Rd Suite 101 Advance NC 27006-8786 | |
| (336) 940-2659 | |
| Not Available |
| Full Name | Advance Family And Sports Medicine Center, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 169 Yadkin Valley Rd, Advance, North Carolina |
| Authorized Official Name and Position | Walter Ezeigbo (OWNER/CEO) |
| Authorized Official Contact | 3369402659 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advance Family And Sports Medicine Center, Pllc 169 Yadkin Valley Rd Suite 101 Advance NC 27006-8786 Ph: (336) 940-2659 | Advance Family And Sports Medicine Center, Pllc 169 Yadkin Valley Rd Suite 101 Advance NC 27006-8786 Ph: (336) 940-2659 |
| NPI Number | 1376854083 |
|---|---|
| Provider Enumeration Date | 06/28/2010 |
| Last Update Date | 11/05/2010 |
| Medicare PECOS PAC ID | 9537351440 |
|---|---|
| Medicare Enrollment ID | O20101011000997 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376854083 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Secondary |
| Provider Name | Walter A Ezeigbo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306839659 PECOS PAC ID: 1052482379 Enrollment ID: I20080613000474 |
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