| Magnolia Family Medicine Pc | |
|
3720 Shipyard Blvd Wilmington NC 28403-6147 | |
| (910) 796-3212 | |
| (910) 796-3216 |
| Full Name | Magnolia Family Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 3720 Shipyard Blvd, Wilmington, North Carolina |
| Authorized Official Name and Position | Richard Adam Gutsin (OWNER) |
| Authorized Official Contact | 9107963212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Family Medicine Pc 3720 Shipyard Blvd Wilmington NC 28403-6147 Ph: (910) 796-3212 | Magnolia Family Medicine Pc 3720 Shipyard Blvd Wilmington NC 28403-6147 Ph: (910) 796-3212 |
| NPI Number | 1639319213 |
|---|---|
| Provider Enumeration Date | 02/23/2009 |
| Last Update Date | 04/29/2020 |
| Medicare PECOS PAC ID | 0244577302 |
|---|---|
| Medicare Enrollment ID | O20190128001294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639319213 | NPI | - | NPPES |
| 7937920 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 9500364 (North Carolina) | Primary |
| Provider Name | Richard A Gutsin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083608145 PECOS PAC ID: 7719010057 Enrollment ID: I20100806000190 |
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