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7124 Knightdale Blvd Knightdale NC 27545-9265 | |
(919) 266-6211 | |
(919) 854-7774 |
Full Name | |
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Speciality | Family Medicine |
Location | 7124 Knightdale Blvd, Knightdale, North Carolina |
Authorized Official Name and Position | David K Moye (SENIOR VICE PRESIDENT) |
Authorized Official Contact | 9198512174 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5420 Wade Park Blvd Ste 106 Raleigh NC 27607-4188 Ph: (919) 851-2174 | 7124 Knightdale Blvd Knightdale NC 27545-9265 Ph: (919) 266-6211 |
NPI Number | 1306899125 |
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Provider Enumeration Date | 05/19/2006 |
Last Update Date | 08/31/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306899125 | NPI | - | NPPES |
5900352 | Medicaid | NC | |
0230X | Other | NC | BCBS |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |