| Ocean Isle Beach Family Medicine. Pc | |
|
120 Causeway Dr Ste 3 Ocean Isle Beach NC 28469-7581 | |
| (910) 575-5004 | |
| (855) 575-0700 |
| Full Name | Ocean Isle Beach Family Medicine. Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 Causeway Dr Ste 3, Ocean Isle Beach, North Carolina |
| Authorized Official Name and Position | Daniel R. Blizzard (PHYSICIAN) |
| Authorized Official Contact | 9105755004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ocean Isle Beach Family Medicine. Pc 120 Causeway Dr Ste 3 Ocean Isle Beach NC 28469-7581 Ph: (910) 575-5004 | Ocean Isle Beach Family Medicine. Pc 120 Causeway Dr Ste 3 Ocean Isle Beach NC 28469-7581 Ph: (910) 575-5004 |
| NPI Number | 1902162928 |
|---|---|
| Provider Enumeration Date | 04/03/2012 |
| Last Update Date | 10/25/2017 |
| Medicare PECOS PAC ID | 2769639541 |
|---|---|
| Medicare Enrollment ID | O20120829000899 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902162928 | NPI | - | NPPES |
| 1902162928 | Other | NPI | |
| 5920193 | Medicaid | NC | |
| B502 | Other | NC | MEDICARE PTAN |
| 34D1040435 | Other | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 181477 (North Carolina) | Primary |
| Provider Name | Daniel R Blizzard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437194354 PECOS PAC ID: 3779508825 Enrollment ID: I20080111000612 |
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