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1035 7 Lakes Dr Ste C West End NC 27376-9081 | |
(910) 673-0045 | |
(910) 673-5705 |
Full Name | |
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Speciality | Family Medicine |
Location | 1035 7 Lakes Dr Ste C, West End, North Carolina |
Authorized Official Name and Position | Mickey Foster (CEO) |
Authorized Official Contact | 9107154473 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1035 7 Lakes Dr Ste C West End NC 27376-9081 Ph: (910) 673-0045 | 1035 7 Lakes Dr Ste C West End NC 27376-9081 Ph: (910) 673-0045 |
NPI Number | 1548290265 |
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Provider Enumeration Date | 07/05/2006 |
Last Update Date | 01/06/2025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548290265 | NPI | - | NPPES |
1548290265 | Medicaid | NC | |
790242L | Medicaid | NC | |
0242L | Other | NC | BCBS |
02AY4 | Other | NC | BCBS # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 103285 (North Carolina) | Primary |