| |
201 Virginia Rd Edenton NC 27932-9668 | |
(252) 482-2116 | |
(252) 482-7631 |
Full Name | |
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Speciality | Family Medicine |
Location | 201 Virginia Rd, Edenton, North Carolina |
Authorized Official Name and Position | Jeffery N. Sackrison (PRESIDENT) |
Authorized Official Contact | 2524826268 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 569 Edenton NC 27932-0569 Ph: (252) 482-2116 | 201 Virginia Rd Edenton NC 27932-9668 Ph: (252) 482-2116 |
NPI Number | 1629239488 |
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Provider Enumeration Date | 06/24/2008 |
Last Update Date | 12/11/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629239488 | NPI | - | NPPES |
019Y1 | Other | NC | BCBS |
5950347 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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