| Hanora Medical Center, Pllc | |
|
2620 Owen Dr Fayetteville NC 28306 | |
| (910) 860-0017 | |
| (910) 860-0015 |
| Full Name | Hanora Medical Center, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2620 Owen Dr, Fayetteville, North Carolina |
| Authorized Official Name and Position | Benjamin Chigbo Udoh (CEO/PRESIDENT) |
| Authorized Official Contact | 9108600017 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hanora Medical Center, Pllc Po Box 88033 Fayetteville NC 28304-8033 Ph: (910) 860-0017 | Hanora Medical Center, Pllc 2620 Owen Dr Fayetteville NC 28306 Ph: (910) 860-0017 |
| NPI Number | 1184928848 |
|---|---|
| Provider Enumeration Date | 01/10/2011 |
| Last Update Date | 07/11/2018 |
| Medicare PECOS PAC ID | 3577748607 |
|---|---|
| Medicare Enrollment ID | O20110504000646 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184928848 | NPI | - | NPPES |
| 5913279 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 2009-01732 (North Carolina) | Primary |
| Provider Name | Benjamin C Udoh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154438455 PECOS PAC ID: 1557383866 Enrollment ID: I20091124000620 |
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