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9615 Kincey Avenue Suite 100 Huntersville NC 28078-9140 | |
(704) 316-5635 | |
(704) 316-5640 |
Full Name | |
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Speciality | Pediatrics |
Location | 9615 Kincey Avenue, Huntersville, 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: (704) 384-7840 | 9615 Kincey Avenue Suite 100 Huntersville NC 28078-9140 Ph: (704) 316-5635 |
NPI Number | 1013969674 |
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Provider Enumeration Date | 05/16/2006 |
Last Update Date | 06/20/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013969674 | NPI | - | NPPES |
017F5 | Other | NC | BCBS-NC |
5902021 | Medicaid | NC | |
CC5118 | Other | NC | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (North Carolina) | Secondary |
208000000X | Pediatrics | (North Carolina) | Primary |
The Independence Center For Hyperbarics And Wellness Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14330 Oakhill Lane, Suite 140, Huntersville, NC 28078 Phone: 704-997-8146 Fax: 704-997-8125 | |