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128 E Broad St Saint Pauls NC 28384-1610 | |
(910) 241-3042 | |
(910) 241-3462 |
Full Name | |
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Speciality | Clinic/Center |
Location | 128 E Broad St, Saint Pauls, North Carolina |
Authorized Official Name and Position | George Timothy Hall (PRESIDENT/CEO) |
Authorized Official Contact | 9105212900 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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60 Commerce Plaza Cir Pembroke NC 28372-7386 Ph: (910) 521-2900 | 128 E Broad St Saint Pauls NC 28384-1610 Ph: (910) 241-3042 |
NPI Number | 1518525526 |
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Provider Enumeration Date | 06/04/2019 |
Last Update Date | 08/13/2019 |
Medicare PECOS PAC ID | 1850290693 |
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Medicare Enrollment ID | O20190829000593 |
Identifier | Type | State | Issuer |
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1518525526 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |