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240 Hospital Dr Ne Bolivia NC 28422-8346 | |
(910) 721-2070 | |
(910) 721-2074 |
Full Name | |
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Speciality | Hospitalist |
Location | 240 Hospital Dr Ne, 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) 721-2070 | 240 Hospital Dr Ne Bolivia NC 28422-8346 Ph: (910) 721-2070 |
NPI Number | 1558551671 |
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Provider Enumeration Date | 07/25/2007 |
Last Update Date | 06/20/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558551671 | NPI | - | NPPES |
5908913 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
208000000X | Pediatrics | (* (Not Available)) | Secondary |
208M00000X | Hospitalist | (* (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 | |