| |
1204 E Fire Tower Rd Greenville NC 27858-4196 | |
(252) 744-1122 | |
(252) 744-1167 |
Full Name | |
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Speciality | Family Medicine |
Location | 1204 E Fire Tower Rd, Greenville, North Carolina |
Authorized Official Name and Position | Jason A Foltz (MEDICAL DIRECTOR) |
Authorized Official Contact | 2527441882 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 751069 Charlotte NC 28275-1069 Ph: () - | 1204 E Fire Tower Rd Greenville NC 27858-4196 Ph: (252) 744-1122 |
NPI Number | 1841248358 |
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Provider Enumeration Date | 05/05/2006 |
Last Update Date | 11/04/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841248358 | NPI | - | NPPES |
0214E | Other | NC | BCBS NC GROUP PROVIDER # |
790214E | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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