| Shalom Medical Pc | |
|
1102 Henderson Dr Jacksonville NC 28540-5203 | |
| (731) 334-9011 | |
| (731) 288-1628 |
| Full Name | Shalom Medical Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1102 Henderson Dr, Jacksonville, North Carolina |
| Authorized Official Name and Position | Benjamin Chukwunonso Mozie (MEDICAL DIRECTOR/PRESIDENT) |
| Authorized Official Contact | 7313349011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shalom Medical Pc 1102 Henderson Dr Jacksonville NC 28540-5203 Ph: (731) 334-9011 | Shalom Medical Pc 1102 Henderson Dr Jacksonville NC 28540-5203 Ph: (731) 334-9011 |
| NPI Number | 1467759985 |
|---|---|
| Provider Enumeration Date | 02/18/2011 |
| Last Update Date | 02/18/2011 |
| Medicare PECOS PAC ID | 6901088335 |
|---|---|
| Medicare Enrollment ID | O20110307000728 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467759985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 2010-01876 (North Carolina) | Primary |
| Provider Name | Benjamin Mozie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639195019 PECOS PAC ID: 3072518372 Enrollment ID: I20110307000807 |
| Provider Name | Joy N Mozie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497156558 PECOS PAC ID: 4082939137 Enrollment ID: I20150211001858 |
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