| Open Water Medical, Pa | |
|
11 Office Park Dr Jacksonville NC 28546-7326 | |
| (910) 353-9906 | |
| (910) 353-4853 |
| Full Name | Open Water Medical, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 11 Office Park Dr, Jacksonville, North Carolina |
| Authorized Official Name and Position | Tisha Rae Smith (PRACTICE MANAGER) |
| Authorized Official Contact | 2527285737 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Open Water Medical, Pa 1620c Live Oak St Beaufort NC 28516-1583 Ph: (252) 728-5737 | Open Water Medical, Pa 11 Office Park Dr Jacksonville NC 28546-7326 Ph: (910) 353-9906 |
| NPI Number | 1497490957 |
|---|---|
| Provider Enumeration Date | 04/29/2022 |
| Last Update Date | 04/29/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497490957 | NPI | - | NPPES |
| 1750482493 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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