| Full Name | |
|---|---|
| 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 |
|---|---|
22 Shipwash Dr Garner NC 27529-6861 Ph: (919) 662-7600 | 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 |
Lans Angels Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 405 Aversboro Rd Ste 400, Garner, NC 27529 Phone: 919-986-7787 | |
Ivory Bloom Health Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 605 Benson Rd Ste A, Garner, NC 27529 Phone: 910-994-8125 | |
Wake Urgent Care & Family Clinic Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5156 Nc Hwy 42 West, Garner, NC 27529 Phone: 919-329-5000 Fax: 919-329-5300 | |
Garner Lighthouse Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 607 Benson Rd, Garner, NC 27529 Phone: 919-594-1354 Fax: 919-594-1369 |