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5641 Poplar Tent Rd Ste 101 Concord NC 28027-7533 | |
(704) 782-1955 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 5641 Poplar Tent Rd, Concord, North Carolina |
Authorized Official Name and Position | Scott Rissmiller (ENTERPRISE EVP) |
Authorized Official Contact | 7043558675 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 19305 Charlotte NC 28219-9305 Ph: (704) 631-0002 | 5641 Poplar Tent Rd Ste 101 Concord NC 28027-7533 Ph: (704) 782-1955 |
NPI Number | 1336370295 |
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Provider Enumeration Date | 07/27/2009 |
Last Update Date | 03/09/2023 |
Medicare PECOS PAC ID | 3375449655 |
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Medicare Enrollment ID | O20100930048183 |
Identifier | Type | State | Issuer |
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1336370295 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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