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122 E Blue St Saint Pauls NC 28384-1812 | |
(910) 865-5177 | |
(910) 865-9400 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 122 E Blue St, Saint Pauls, North Carolina |
Authorized Official Name and Position | Laticia Ann Tharrington (OWNER) |
Authorized Official Contact | 9108655177 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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122 E Blue St Saint Pauls NC 28384-1812 Ph: (910) 865-5177 | 122 E Blue St Saint Pauls NC 28384-1812 Ph: (910) 865-5177 |
NPI Number | 1649663030 |
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Provider Enumeration Date | 03/10/2015 |
Last Update Date | 08/27/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649663030 | NPI | - | NPPES |
1184694960 | Other | NC | NPI |
2592580 | Other | NC | PTAN |
7004391 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 5000713 (North Carolina) | Primary |