| Divine Family Practice And Urgent Care, Pllc | |
|
3616 Cape Center Dr Fayetteville NC 28304-4456 | |
| (910) 779-0780 | |
| (910) 779-0896 |
| Full Name | Divine Family Practice And Urgent Care, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3616 Cape Center Dr, Fayetteville, North Carolina |
| Authorized Official Name and Position | Abimbola Ogunleye-kolawole (PRESIDENT) |
| Authorized Official Contact | 9107790780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Family Practice And Urgent Care, Pllc 3616 Cape Center Dr Fayetteville NC 28304-4456 Ph: (910) 779-0780 | Divine Family Practice And Urgent Care, Pllc 3616 Cape Center Dr Fayetteville NC 28304-4456 Ph: (910) 779-0780 |
| NPI Number | 1477197168 |
|---|---|
| Provider Enumeration Date | 11/05/2019 |
| Last Update Date | 08/30/2023 |
| Medicare PECOS PAC ID | 1759712383 |
|---|---|
| Medicare Enrollment ID | O20200514000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477197168 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | Patricia E Chisum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164470266 PECOS PAC ID: 7618934621 Enrollment ID: I20080131000348 |
| Provider Name | Abimbola Ogunleye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023294261 PECOS PAC ID: 7214010495 Enrollment ID: I20100331001288 |
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