| |
1006b Wh Smith Blvd Greenville NC 27834-5051 | |
(252) 830-9001 | |
(252) 830-9002 |
Full Name | |
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Speciality | Internal Medicine |
Location | 1006b Wh Smith Blvd, Greenville, North Carolina |
Authorized Official Name and Position | Myriam M Daniel (CEO) |
Authorized Official Contact | 2528309001 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1025 Wh Smith Blvd Ste 106 Greenville NC 27834-5278 Ph: (252) 830-9001 | 1006b Wh Smith Blvd Greenville NC 27834-5051 Ph: (252) 830-9001 |
NPI Number | 1215048145 |
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Provider Enumeration Date | 08/31/2006 |
Last Update Date | 01/06/2015 |
Medicare PECOS PAC ID | 3870525983 |
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Medicare Enrollment ID | O20080123000299 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215048145 | NPI | - | NPPES |
8927025 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 9401167 (North Carolina) | Primary |
Provider Name | Myriam Daniel |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1831200757 PECOS PAC ID: 1951333061 Enrollment ID: I20050909000835 |
Provider Name | Jevita Denise Terry |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508016908 PECOS PAC ID: 2264628155 Enrollment ID: I20101117001305 |
Provider Name | Lakeisha Marie Lewis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477110971 PECOS PAC ID: 8921337726 Enrollment ID: I20190904000447 |
Provider Name | Nadiah Mahmoud |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1134900236 PECOS PAC ID: 5092151563 Enrollment ID: I20240307001391 |
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