Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 108 W Main St, Woodland, North Carolina |
Authorized Official Name and Position | Stephanie Wroten (INTERIM CEO) |
Authorized Official Contact | 2522090237 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 669 Ahoskie NC 27910-0669 Ph: (252) 209-0237 | 108 W Main St Woodland NC 27897 Ph: (252) 587-3141 |
NPI Number | 1023675113 |
---|---|
Provider Enumeration Date | 05/23/2019 |
Last Update Date | 03/28/2024 |
Medicare PECOS PAC ID | 7214983386 |
---|---|
Medicare Enrollment ID | O20200602003143 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023675113 | NPI | - | NPPES |
1023675113 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Nancy Arleen Vanhoozer |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1831516368 PECOS PAC ID: 7719110519 Enrollment ID: I20160531000550 |