| Lifesource Prime Inc | |
|
3205 Randall Pkwy Ste 105 Wilmington NC 28403-2565 | |
| (910) 742-9243 | |
| Not Available |
| Full Name | Lifesource Prime Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3205 Randall Pkwy Ste 105, Wilmington, North Carolina |
| Authorized Official Name and Position | Peggy Baddour (CEO) |
| Authorized Official Contact | 9107429243 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Prime Inc Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 338-2882 | Lifesource Prime Inc 3205 Randall Pkwy Ste 105 Wilmington NC 28403-2565 Ph: (910) 742-9243 |
| NPI Number | 1598533275 |
|---|---|
| Provider Enumeration Date | 12/13/2023 |
| Last Update Date | 12/27/2023 |
| Medicare PECOS PAC ID | 7810336385 |
|---|---|
| Medicare Enrollment ID | O20240416003922 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598533275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jatel Shukla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467854224 PECOS PAC ID: 6204154628 Enrollment ID: I20150415002118 |
Southside Medical Center Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1925a Oleander Dr, Wilmington, NC 28403 Phone: 910-251-7715 Fax: 910-763-7845 | |
Southcare Minute Clinic Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1506 Market St, Wilmington, NC 28401 Phone: 910-254-4065 Fax: 910-763-8258 | |
Act Medical Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 311 Judges Rd Ste 4e, Wilmington, NC 28405 Phone: 910-791-6767 Fax: 910-791-8490 | |
Rising Integrative Healthcare Of Wilmington, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5 Silva Terra Dr Ste 100, Wilmington, NC 28412 Phone: 910-530-3031 | |
Nhrmc Care Team (acute) Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2131 S 17th St, Wilmington, NC 28401 Phone: 910-662-9300 | |
Carolina Joint And Arthritis Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5725 Oleander Dr Ste E4, Wilmington, NC 28403 Phone: 910-769-7878 Fax: 910-769-8967 | |
Dawson Med Uregent Care, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 608 Dawson St Ste 101, Wilmington, NC 28401 Phone: 910-387-3788 Fax: 833-941-2261 |