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4222 Long Beach Rd Se Southport NC 28461-8627 | |
(910) 454-1197 | |
(910) 454-4330 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4222 Long Beach Rd Se, Southport, North Carolina |
Authorized Official Name and Position | Thomas R Seimers (CEO) |
Authorized Official Contact | 9104573910 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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924 N Howe St Southport NC 28461-3038 Ph: (910) 457-3800 | 4222 Long Beach Rd Se Southport NC 28461-8627 Ph: (910) 454-1197 |
NPI Number | 1568887818 |
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Provider Enumeration Date | 02/24/2014 |
Last Update Date | 02/24/2014 |
Medicare PECOS PAC ID | 8921910324 |
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Medicare Enrollment ID | O20140516001773 |
Identifier | Type | State | Issuer |
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1568887818 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | H0150 (North Carolina) | Primary |
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