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128 E Broad St Saint Pauls NC 28384-1610 | |
(910) 865-5955 | |
(910) 738-3764 |
Full Name | |
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Speciality | Clinic/center |
Location | 128 E Broad St, Saint Pauls, North Carolina |
Authorized Official Name and Position | Charles T. 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) 272-3051 | 128 E Broad St Saint Pauls NC 28384-1610 Ph: (910) 865-5955 |
NPI Number | 1750518692 |
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Provider Enumeration Date | 06/18/2009 |
Last Update Date | 06/18/2009 |
Identifier | Type | State | Issuer |
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1750518692 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | H0064 (North Carolina) | Primary |