| Pura Clinic Family Medicine Pc | |
|
124 Baywood Rd Suite 111 Fayetteville NC 28312-9136 | |
| (910) 829-0143 | |
| (910) 829-5107 |
| Full Name | Pura Clinic Family Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 124 Baywood Rd, Fayetteville, North Carolina |
| Authorized Official Name and Position | Mohamad A Shakir (OWNER/MD) |
| Authorized Official Contact | 9108290143 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pura Clinic Family Medicine Pc 124 Baywood Rd Suite 111 Fayetteville NC 28312-9136 Ph: (910) 829-0143 | Pura Clinic Family Medicine Pc 124 Baywood Rd Suite 111 Fayetteville NC 28312-9136 Ph: (910) 829-0143 |
| NPI Number | 1487077491 |
|---|---|
| Provider Enumeration Date | 01/27/2014 |
| Last Update Date | 11/10/2014 |
| Medicare PECOS PAC ID | 2668605528 |
|---|---|
| Medicare Enrollment ID | O20140429001716 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487077491 | NPI | - | NPPES |
| 1487077491 | Medicaid | NC | |
| 148J4 | Other | NC | BCBSNC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mohamad A Shakir |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689792830 PECOS PAC ID: 9537231923 Enrollment ID: I20080630000304 |
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