| |
104 E Lakeview Dr Trenton NC 28585-8893 | |
(252) 448-4321 | |
(252) 448-1073 |
Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 104 E Lakeview Dr, Trenton, North Carolina |
Authorized Official Name and Position | Reba W. Futrell (EXECUTIVE ASSISTANT/CREDENTIALING) |
Authorized Official Contact | 9102679997 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
412 Sw Center St Faison NC 28341-8820 Ph: (910) 267-0421 | 104 E Lakeview Dr Trenton NC 28585-8893 Ph: (252) 448-4321 |
NPI Number | 1750407128 |
---|---|
Provider Enumeration Date | 03/21/2007 |
Last Update Date | 08/03/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750407128 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |