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10207 Cerny St Ste 210 Raleigh NC 27617-4887 | |
(800) 266-3853 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 10207 Cerny St Ste 210, Raleigh, North Carolina |
Authorized Official Name and Position | John Stuart Smith (VP FINANCE) |
Authorized Official Contact | 9196138995 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 110566 Durham NC 27709-5566 Ph: (919) 620-4855 | 10207 Cerny St Ste 210 Raleigh NC 27617-4887 Ph: (800) 266-3853 |
NPI Number | 1740978386 |
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Provider Enumeration Date | 05/01/2023 |
Last Update Date | 09/12/2023 |
Medicare PECOS PAC ID | 8325412737 |
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Medicare Enrollment ID | O20240122004118 |
Identifier | Type | State | Issuer |
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1740978386 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Secondary |
261QA1903X | Clinic/center - Ambulatory Surgical | (* (Not Available)) | Primary |
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