| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 103 Cotton Creek Rd, Star, North Carolina |
| Authorized Official Name and Position | George Timothy Hall (PRESIDENT/CEO) |
| Authorized Official Contact | 9105212900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
60 Commerce Plz Pembroke NC 28372-7386 Ph: (910) 521-2900 | 103 Cotton Creek Rd Star NC 27356 Ph: (910) 428-9020 |
| NPI Number | 1629334016 |
|---|---|
| Provider Enumeration Date | 04/10/2012 |
| Last Update Date | 08/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629334016 | NPI | - | NPPES |
| 344054A | Medicaid | NC | |
| 026KU | Other | NC | BCBS |
| 344054C | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Cnc Family Medicine, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 128 Okeewemee Star Rd, Star, NC 27356 Phone: 910-428-1111 Fax: 910-428-2506 |