| |
360 E Charity Rd Rose Hill NC 28458-8303 | |
(910) 289-3086 | |
(910) 289-2413 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 360 E Charity Rd, Rose Hill, North Carolina |
Authorized Official Name and Position | Reba W. Futrell (EXECUTIVE ASSISTANT CREDENTIALING) |
Authorized Official Contact | 9102679997 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
412 Sw Center St Faison NC 28341-8820 Ph: (910) 267-0421 | 360 E Charity Rd Rose Hill NC 28458-8303 Ph: (910) 289-3086 |
NPI Number | 1801911383 |
---|---|
Provider Enumeration Date | 03/21/2007 |
Last Update Date | 08/19/2010 |
Medicare PECOS PAC ID | 3173434479 |
---|---|
Medicare Enrollment ID | O20101005000551 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801911383 | NPI | - | NPPES |
0122C | Other | NC | BCBS |
344557A | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |