| |
911 Hay St Fayetteville NC 28305-5313 | |
(910) 486-6818 | |
(910) 302-5464 |
Full Name | |
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Speciality | Clinic/Center |
Location | 911 Hay St, Fayetteville, North Carolina |
Authorized Official Name and Position | Gregory M Bounds (CEO) |
Authorized Official Contact | 9102671237 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 187 Faison NC 28341-0187 Ph: (910) 267-2042 | 911 Hay St Fayetteville NC 28305-5313 Ph: (910) 486-6818 |
NPI Number | 1902474547 |
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Provider Enumeration Date | 06/10/2021 |
Last Update Date | 01/29/2025 |
Medicare PECOS PAC ID | 3173434479 |
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Medicare Enrollment ID | O20210707001243 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902474547 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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