| Coastal Carolina Family Practice Pa | |
|
600 S Church St Hertford NC 27944-1205 | |
| (252) 426-5711 | |
| (252) 426-1999 |
| Full Name | Coastal Carolina Family Practice Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 600 S Church St, Hertford, North Carolina |
| Authorized Official Name and Position | Chris A Lane (MEDICAL ADM) |
| Authorized Official Contact | 2524265711 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Carolina Family Practice Pa Po Box 650 Hertford NC 27944-0650 Ph: (252) 426-5711 | Coastal Carolina Family Practice Pa 600 S Church St Hertford NC 27944-1205 Ph: (252) 426-5711 |
| NPI Number | 1326031485 |
|---|---|
| Provider Enumeration Date | 08/24/2005 |
| Last Update Date | 07/09/2010 |
| Medicare PECOS PAC ID | 6901985688 |
|---|---|
| Medicare Enrollment ID | O20080506000716 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326031485 | NPI | - | NPPES |
| 0222L | Other | NC | BCBS |
| 044647 | Other | TRIGON | |
| 890222L | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 40834 (North Carolina) | Primary |
| Provider Name | Timothy C Madigan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013965060 PECOS PAC ID: 6608808829 Enrollment ID: I20050908000196 |
| Provider Name | Robert E Lane |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023001500 PECOS PAC ID: 7911086699 Enrollment ID: I20080506000707 |