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123 Professional Park Dr Locust NC 28097-7712 | |
(704) 403-6760 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 123 Professional Park Dr, Locust, North Carolina |
Authorized Official Name and Position | Scott Rissmiller (ENTERPRISE EVP) |
Authorized Official Contact | 7043558675 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 19305 Charlotte NC 28219-9305 Ph: (704) 631-0002 | 123 Professional Park Dr Locust NC 28097-7712 Ph: (704) 403-6760 |
NPI Number | 1225268170 |
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Provider Enumeration Date | 07/24/2009 |
Last Update Date | 03/09/2023 |
Identifier | Type | State | Issuer |
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1225268170 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |