| |
128 E Broad St Saint Pauls NC 28384-1610 | |
(910) 865-5955 | |
(910) 865-3055 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 128 E Broad St, Saint Pauls, North Carolina |
Authorized Official Name and Position | Charles Thomas Johnson (CFO) |
Authorized Official Contact | 9106715090 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2600 N Elm St Lumberton NC 28358-3011 Ph: (910) 737-3147 | 128 E Broad St Saint Pauls NC 28384-1610 Ph: (910) 865-5955 |
NPI Number | 1710979430 |
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Provider Enumeration Date | 08/18/2005 |
Last Update Date | 01/27/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710979430 | NPI | - | NPPES |
011MW | Other | NC | BLUE CROSS BLUE SHIELD |
343999C | Medicaid | NC | |
343999A | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | H0064 (North Carolina) | Primary |