| |
11200 Governor Manly Way Suite 205 Raleigh NC 27614-6830 | |
(919) 570-7700 | |
(919) 570-7701 |
Full Name | |
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Speciality | Family Medicine |
Location | 11200 Governor Manly Way, Raleigh, North Carolina |
Authorized Official Name and Position | Bernadette M Spong (CFO) |
Authorized Official Contact | 9197843245 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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11200 Governor Manly Way Suite 205 Raleigh NC 27614-6830 Ph: (919) 570-7700 | 11200 Governor Manly Way Suite 205 Raleigh NC 27614-6830 Ph: (919) 570-7700 |
NPI Number | 1750319729 |
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Provider Enumeration Date | 06/29/2006 |
Last Update Date | 04/28/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750319729 | NPI | - | NPPES |
89014XV | Medicaid | NC | |
7607516 | Other | AETNA | |
014XV | Other | NC | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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