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2950 Pine Forest Parkway Suite 201 Bolivia NC 28422-6800 | |
(910) 454-4032 | |
(910) 754-4580 |
Full Name | |
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Speciality | Family Medicine |
Location | 2950 Pine Forest Parkway, Bolivia, North Carolina |
Authorized Official Name and Position | Leea Jeanine Walton (RCS MANAGER) |
Authorized Official Contact | 7043166081 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 60447 Charlotte NC 28260-0447 Ph: (910) 454-4032 | 2950 Pine Forest Parkway Suite 201 Bolivia NC 28422-6800 Ph: (910) 454-4032 |
NPI Number | 1043564891 |
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Provider Enumeration Date | 11/01/2012 |
Last Update Date | 07/09/2024 |
Identifier | Type | State | Issuer |
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1043564891 | NPI | - | NPPES |
1043564891 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Tri County Community Health Council Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4311 Old Ocean Highway, Bolivia, NC 28422 Phone: 877-935-5255 Fax: 910-236-2118 | |