| Boiling Spring Lakes Family Medicine, Pc | |
|
3599 George Ii Hwy Southport NC 28461-7793 | |
| (910) 845-3244 | |
| (910) 845-3276 |
| Full Name | Boiling Spring Lakes Family Medicine, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 3599 George Ii Hwy, Southport, North Carolina |
| Authorized Official Name and Position | Domenic A Palagruto (OWNER) |
| Authorized Official Contact | 9108453244 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boiling Spring Lakes Family Medicine, Pc 3599 George Ii Hwy Southport NC 28461-7793 Ph: (910) 845-3244 | Boiling Spring Lakes Family Medicine, Pc 3599 George Ii Hwy Southport NC 28461-7793 Ph: (910) 845-3244 |
| NPI Number | 1730275090 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6901868587 |
|---|---|
| Medicare Enrollment ID | O20041027000764 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730275090 | NPI | - | NPPES |
| 8913720 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (North Carolina) | Primary |
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