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208 North Broad Street Columbia NC 27925 | |
(252) 796-0689 | |
(252) 796-0690 |
Full Name | |
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Speciality | Clinic/Center |
Location | 208 North Broad Street, Columbia, North Carolina |
Authorized Official Name and Position | Irene Leibensperger-cavall (MEDICAL DIRECTOR) |
Authorized Official Contact | 2527960689 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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208 North Broad St Columbia NC 27925-9705 Ph: (252) 796-0689 | 208 North Broad Street Columbia NC 27925 Ph: (252) 796-0689 |
NPI Number | 1477583102 |
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Provider Enumeration Date | 07/05/2006 |
Last Update Date | 07/16/2018 |
Medicare PECOS PAC ID | 7911960257 |
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Medicare Enrollment ID | O20041108001233 |
Identifier | Type | State | Issuer |
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1477583102 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (North Carolina) | Primary |
Provider Name | Irene Liebensperger-cavall |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407942196 PECOS PAC ID: 6608830161 Enrollment ID: I20041115000604 |