| Edgewater Medical Center And Urgent Care | |
|
100 S 10th Street Lillington NC 27546-6690 | |
| (910) 893-4111 | |
| (910) 893-9850 |
| Full Name | Edgewater Medical Center And Urgent Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 100 S 10th Street, Lillington, North Carolina |
| Authorized Official Name and Position | Rodolfo C Reyes (OWNER/MANAGER) |
| Authorized Official Contact | 9108934111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgewater Medical Center And Urgent Care 100 S 10th Street Lillington NC 27546-6690 Ph: (910) 893-4111 | Edgewater Medical Center And Urgent Care 100 S 10th Street Lillington NC 27546-6690 Ph: (910) 893-4111 |
| NPI Number | 1205865979 |
|---|---|
| Provider Enumeration Date | 07/03/2006 |
| Last Update Date | 11/09/2023 |
| Medicare PECOS PAC ID | 5395635171 |
|---|---|
| Medicare Enrollment ID | O20040316001267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205865979 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| 213E00000X | Podiatrist | (* (Not Available)) | Secondary |
| Provider Name | Rodolfo Constantino Reyes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184653834 PECOS PAC ID: 7911819628 Enrollment ID: I20040818000056 |
| Provider Name | Carla Hamilton Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356508360 PECOS PAC ID: 3476722851 Enrollment ID: I20110802000409 |
| Provider Name | Monica Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780169623 PECOS PAC ID: 1355695164 Enrollment ID: I20181114002205 |
| Provider Name | Elizabeth Laney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215410139 PECOS PAC ID: 1759635477 Enrollment ID: I20181116000196 |
| Provider Name | Nicayla Polanco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194347922 PECOS PAC ID: 5991116584 Enrollment ID: I20201203001750 |
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