| Elitecare Of Fayetteville Pllc | |
|
3622 N Main St Hope Mills NC 28348-1937 | |
| (910) 423-7771 | |
| (910) 423-4177 |
| Full Name | Elitecare Of Fayetteville Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3622 N Main St, Hope Mills, North Carolina |
| Authorized Official Name and Position | Travis Sanders Ross (ORGANIZER/MEMBER) |
| Authorized Official Contact | 9105518882 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elitecare Of Fayetteville Pllc 3622 N Main St Hope Mills NC 28348-1937 Ph: (910) 423-7771 | Elitecare Of Fayetteville Pllc 3622 N Main St Hope Mills NC 28348-1937 Ph: (910) 423-7771 |
| NPI Number | 1508297003 |
|---|---|
| Provider Enumeration Date | 12/09/2013 |
| Last Update Date | 12/09/2013 |
| Medicare PECOS PAC ID | 0749419893 |
|---|---|
| Medicare Enrollment ID | O20140212001136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508297003 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
| Provider Name | Kenneth E Locklear |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275530594 PECOS PAC ID: 8123073566 Enrollment ID: I20050317000916 |
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