| Primary Care Of St. Pauls, Llc | |
|
122 East Blue Street St. Pauls NC 28384 | |
| (910) 865-5177 | |
| (910) 865-9400 |
| Full Name | Primary Care Of St. Pauls, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 122 East Blue Street, St. Pauls, North Carolina |
| Authorized Official Name and Position | Mohamed B Osman (OWNER) |
| Authorized Official Contact | 9108655177 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Of St. Pauls, Llc P O Box 9940 Fayetteville NC 28311-9940 Ph: (910) 865-5177 | Primary Care Of St. Pauls, Llc 122 East Blue Street St. Pauls NC 28384 Ph: (910) 865-5177 |
| NPI Number | 1699960302 |
|---|---|
| Provider Enumeration Date | 09/06/2007 |
| Last Update Date | 08/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699960302 | NPI | - | NPPES |
| 5900350 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | 2002-01142 (North Carolina) | Primary |
Three Rivers Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 580 W. Mclean St., St. Pauls, NC 28384 Phone: 910-865-3063 Fax: 918-653-5063 |