| |
2066 Hwy 125 Roanoke Rapids NC 27870 | |
(252) 536-5000 | |
(252) 536-2258 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2066 Hwy 125, Roanoke Rapids, North Carolina |
Authorized Official Name and Position | Judy Belch Beasley (CORPORATE COMPLIANCE OFFICER) |
Authorized Official Contact | 2525365791 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 640 Roanoke Rapids NC 27870-0640 Ph: (252) 536-5791 | 2066 Hwy 125 Roanoke Rapids NC 27870 Ph: (252) 536-5000 |
NPI Number | 1720030232 |
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Provider Enumeration Date | 05/16/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 9739090226 |
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Medicare Enrollment ID | O20030818000036 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720030232 | NPI | - | NPPES |
02609 | Other | NC | BCBS OF NORTH CAROLINA |
344593 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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