| Greenville Family Doctors, Pa | |
|
800 Moye Blvd Ste A Greenville NC 27834-3777 | |
| (252) 752-7133 | |
| (252) 752-6120 |
| Full Name | Greenville Family Doctors, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 800 Moye Blvd Ste A, Greenville, North Carolina |
| Authorized Official Name and Position | Quentin Alexander Mewborn (PRESIDENT) |
| Authorized Official Contact | 2527527133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenville Family Doctors, Pa 800 Moye Blvd Ste A Greenville NC 27834-3777 Ph: (252) 752-7133 | Greenville Family Doctors, Pa 800 Moye Blvd Ste A Greenville NC 27834-3777 Ph: (252) 752-7133 |
| NPI Number | 1629129119 |
|---|---|
| Provider Enumeration Date | 01/13/2007 |
| Last Update Date | 05/04/2020 |
| Medicare PECOS PAC ID | 2365348927 |
|---|---|
| Medicare Enrollment ID | O20071026000589 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629129119 | NPI | - | NPPES |
| 8901678 | Medicaid | NC | |
| 230285 | Other | NC | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Quentin A Mewborn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831240308 PECOS PAC ID: 2961308523 Enrollment ID: I20041215000983 |
| Provider Name | Phillip W Covington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720139215 PECOS PAC ID: 8325005689 Enrollment ID: I20041217000707 |
| Provider Name | Gonzalo Becerra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750518106 PECOS PAC ID: 4284881822 Enrollment ID: I20120904000330 |
| Provider Name | Krystal Gladson Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598363681 PECOS PAC ID: 2860894722 Enrollment ID: I20210714002934 |
| Provider Name | Kenzie Midgette Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578136859 PECOS PAC ID: 2264820570 Enrollment ID: I20211019001053 |
| Provider Name | Bradley Carlyle Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568155018 PECOS PAC ID: 1658718846 Enrollment ID: I20240323000003 |
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