| Cleveland Family Health Clinic, Pllc | |
|
22 Shipwash Drive Garner NC 27529 | |
| (919) 662-7600 | |
| (919) 662-7675 |
| Full Name | Cleveland Family Health Clinic, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 22 Shipwash Drive, Garner, North Carolina |
| Authorized Official Name and Position | Marian J. Bullard (OWNER) |
| Authorized Official Contact | 9196627600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cleveland Family Health Clinic, Pllc 22 Shipwash Dr Garner NC 27529-6861 Ph: (919) 662-7600 | Cleveland Family Health Clinic, Pllc 22 Shipwash Drive Garner NC 27529 Ph: (919) 662-7600 |
| NPI Number | 1235515446 |
|---|---|
| Provider Enumeration Date | 08/11/2015 |
| Last Update Date | 02/06/2019 |
| Medicare PECOS PAC ID | 6800192402 |
|---|---|
| Medicare Enrollment ID | O20160308001660 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235515446 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2011-00283 (North Carolina) | Primary |
| 363A00000X | Physician Assistant | 0010-01664 (North Carolina) | Secondary |
| Provider Name | Stephen M Keen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1619946829 PECOS PAC ID: 9739271891 Enrollment ID: I20110328000096 |
| Provider Name | Jamie H Bledsoe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558986398 PECOS PAC ID: 0042639072 Enrollment ID: I20200924002295 |
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