| Gate City Primary Care Center | |
|
3411 W Wendover Ave Ste D Greensboro NC 27407-1526 | |
| (336) 558-4665 | |
| Not Available |
| Full Name | Gate City Primary Care Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 3411 W Wendover Ave Ste D, Greensboro, North Carolina |
| Authorized Official Name and Position | Mobolaji B. Bakare (OWNER) |
| Authorized Official Contact | 3365584665 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gate City Primary Care Center Po Box 39175 Greensboro NC 27438-9175 Ph: (336) 558-4665 | Gate City Primary Care Center 3411 W Wendover Ave Ste D Greensboro NC 27407-1526 Ph: (336) 558-4665 |
| NPI Number | 1295265221 |
|---|---|
| Provider Enumeration Date | 06/13/2017 |
| Last Update Date | 07/31/2017 |
| Medicare PECOS PAC ID | 9032480777 |
|---|---|
| Medicare Enrollment ID | O20170731000118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295265221 | NPI | - | NPPES |
| 5902086 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 2005-01273 (North Carolina) | Primary |
| Provider Name | Mobolaji B Bakare |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1437106887 PECOS PAC ID: 7911931852 Enrollment ID: I20050924000201 |
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