| Lyon Park Clinic | |
|
1313 Halley St Durham NC 27707-1227 | |
| (919) 536-4205 | |
| (919) 536-1221 |
| Full Name | Lyon Park Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1313 Halley St, Durham, North Carolina |
| Authorized Official Name and Position | Claretta Foye (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9199564022 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lyon Park Clinic Po Box 52119 Durham NC 27717-2119 Ph: (919) 956-4000 | Lyon Park Clinic 1313 Halley St Durham NC 27707-1227 Ph: (919) 536-4205 |
| NPI Number | 1598709198 |
|---|---|
| Provider Enumeration Date | 06/15/2006 |
| Last Update Date | 07/28/2022 |
| Medicare PECOS PAC ID | 4587642590 |
|---|---|
| Medicare Enrollment ID | O20041101000603 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598709198 | NPI | - | NPPES |
| 344500C | Medicaid | NC | |
| 03055 | Other | NC | NC BC/BS PROV NO |
| 344500A | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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