| Village Internal Medicine, Pa | |
|
1843 Quiet Cv Fayetteville NC 28304-3857 | |
| (910) 483-8080 | |
| (910) 483-3258 |
| Full Name | Village Internal Medicine, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 1843 Quiet Cv, Fayetteville, North Carolina |
| Authorized Official Name and Position | Stephen Stuart Logue (PRESIDENT) |
| Authorized Official Contact | 9104838080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Village Internal Medicine, Pa 1843 Quiet Cv Fayetteville NC 28304-3857 Ph: (910) 483-8080 | Village Internal Medicine, Pa 1843 Quiet Cv Fayetteville NC 28304-3857 Ph: (910) 483-8080 |
| NPI Number | 1326074592 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 03/02/2010 |
| Medicare PECOS PAC ID | 4880785823 |
|---|---|
| Medicare Enrollment ID | O20070806000735 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326074592 | NPI | - | NPPES |
| 890296P | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 62468 (North Carolina) | Primary |
| Provider Name | Sathyamurthy Viswanath |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861467581 PECOS PAC ID: 6406883065 Enrollment ID: I20070807000536 |
| Provider Name | Toni Davis Meeks |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780617514 PECOS PAC ID: 2062503006 Enrollment ID: I20111213000112 |
| Provider Name | Stephen Stuart Logue |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013946698 PECOS PAC ID: 4789775727 Enrollment ID: I20111213000140 |
| Provider Name | Ka Blia Lo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447878194 PECOS PAC ID: 6002227261 Enrollment ID: I20201119003486 |
| Provider Name | Wikrom Chaiwatcharayut |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306259809 PECOS PAC ID: 1658672951 Enrollment ID: I20210729000763 |
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