| |
1001 W. Martin Luther King Jr. Dr. Maxton NC 28364 | |
(910) 844-4077 | |
(910) 844-5840 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1001 W. Martin Luther King Jr. Dr., Maxton, North Carolina |
Authorized Official Name and Position | Lucien Stonge (CFO) |
Authorized Official Contact | 9102917547 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 604093 Charlotte NC 28260-4093 Ph: (910) 291-7000 | 1001 W. Martin Luther King Jr. Dr. Maxton NC 28364 Ph: (910) 844-4077 |
NPI Number | 1417941352 |
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Provider Enumeration Date | 09/07/2005 |
Last Update Date | 09/22/2022 |
Medicare PECOS PAC ID | 0648208504 |
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Medicare Enrollment ID | O20030630000016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417941352 | NPI | - | NPPES |
34-3987 | Medicaid | NC | |
0262L | Other | NC | BCBS |
NPA922 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (North Carolina) | Primary |
Shoeheel Medical Arts Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 102 Pine Street, Maxton, NC 28364 Phone: 910-844-5681 Fax: 910-844-5650 |