| Wagram Family Practice | |
|
24420 Marlboro St Wagram NC 28396-9600 | |
| (910) 369-3136 | |
| (910) 369-4756 |
| Full Name | Wagram Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 24420 Marlboro St, Wagram, North Carolina |
| Authorized Official Name and Position | Lucien Stonge (CFO) |
| Authorized Official Contact | 9102917547 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wagram Family Practice 24420 Marlboro St Wagram NC 28396-9600 Ph: (910) 369-3136 | Wagram Family Practice 24420 Marlboro St Wagram NC 28396-9600 Ph: (910) 369-3136 |
| NPI Number | 1891789970 |
|---|---|
| Provider Enumeration Date | 09/06/2005 |
| Last Update Date | 08/31/2022 |
| Medicare PECOS PAC ID | 0648208504 |
|---|---|
| Medicare Enrollment ID | O20210426002437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891789970 | NPI | - | NPPES |
| 07171 | Other | NC | BCBS |
| 89018PZ | Medicaid | NC | |
| 891261T | Medicaid | NC | |
| NPB192 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Wagram Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 24420 Marlboro Street, Wagram, NC 28396 Phone: 919-369-3136 Fax: 910-369-4756 |