Full Name | |
---|---|
Speciality | Clinic/center |
Location | 167 Moore Rd, King, North Carolina |
Authorized Official Name and Position | Christian Fletcher (CEO) |
Authorized Official Contact | 3365935311 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
167 Moore Rd King NC 27021-8770 Ph: (336) 983-6898 | 167 Moore Rd King NC 27021-8770 Ph: (336) 983-6898 |
NPI Number | 1649713462 |
---|---|
Provider Enumeration Date | 11/28/2016 |
Last Update Date | 03/22/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649713462 | NPI | - | NPPES |
H0165 | Other | NC | HOSPITAL LICENSURE |
G557 | Other | NC | MEDICARE PART B PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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