| |
229 Bay Point Dr Edenton NC 27932-8032 | |
(252) 339-4525 | |
(888) 379-3488 |
Full Name | |
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Speciality | Internal Medicine |
Location | 229 Bay Point Dr, Edenton, North Carolina |
Authorized Official Name and Position | Jeffrey F. Severa (OWNER/MANAGER) |
Authorized Official Contact | 2523394525 |
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 697 Edenton NC 27932-0697 Ph: (252) 339-4525 | 229 Bay Point Dr Edenton NC 27932-8032 Ph: (252) 339-4525 |
NPI Number | 1093018095 |
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Provider Enumeration Date | 12/13/2010 |
Last Update Date | 12/13/2010 |
Medicare PECOS PAC ID | 7214117498 |
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Medicare Enrollment ID | O20110204000367 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093018095 | NPI | - | NPPES |
89137KR | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | NC200400743 (Pennsylvania) | Primary |
Provider Name | Jeffrey Francis Severa |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1215928403 PECOS PAC ID: 7618942475 Enrollment ID: I20041103001038 |
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