| Hardee Family Medicine Pa | |
|
444 Williamson Rd Suite E Mooresville NC 28117 | |
| (704) 658-9779 | |
| (704) 658-9773 |
| Full Name | Hardee Family Medicine Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 444 Williamson Rd Suite E, Mooresville, North Carolina |
| Authorized Official Name and Position | Michael Wayne Hardee (OWNER/PRESIDENT) |
| Authorized Official Contact | 7046589779 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hardee Family Medicine Pa 444 Williamson Rd Ste E Mooresville NC 28117-9248 Ph: (704) 658-9779 | Hardee Family Medicine Pa 444 Williamson Rd Suite E Mooresville NC 28117 Ph: (704) 658-9779 |
| NPI Number | 1881640035 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 08/13/2015 |
| Medicare PECOS PAC ID | 6103886403 |
|---|---|
| Medicare Enrollment ID | O20041012000750 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881640035 | NPI | - | NPPES |
| 34D1027431 | Other | NC | CLIA MEDICARE/MEDICAID |
| 7902629 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 200000816 (North Carolina) | Primary |
| Provider Name | Michael W Hardee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720075955 PECOS PAC ID: 5991765208 Enrollment ID: I20120112000214 |
| Provider Name | Brooke Amalea Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457872038 PECOS PAC ID: 1557628252 Enrollment ID: I20171206000057 |
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