| Wellington Provider Group Pc | |
|
421 Fayetteville St Ste 1100 Raleigh NC 27601-3000 | |
| (859) 518-8817 | |
| (859) 201-1084 |
| Full Name | Wellington Provider Group Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 421 Fayetteville St Ste 1100, Raleigh, North Carolina |
| Authorized Official Name and Position | Mariela Bravo (CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 8595188817 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellington Provider Group Pc 535 Wellington Way Ste 330 Lexington KY 40503-1331 Ph: (859) 518-8817 | Wellington Provider Group Pc 421 Fayetteville St Ste 1100 Raleigh NC 27601-3000 Ph: (859) 518-8817 |
| NPI Number | 1922710045 |
|---|---|
| Provider Enumeration Date | 12/20/2022 |
| Last Update Date | 12/20/2022 |
| Medicare PECOS PAC ID | 8123412459 |
|---|---|
| Medicare Enrollment ID | O20230130000867 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922710045 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jeffrey Graham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609830918 PECOS PAC ID: 5395789507 Enrollment ID: I20050617000285 |
| Provider Name | Kyle George |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982199519 PECOS PAC ID: 4688909690 Enrollment ID: I20230208002298 |
| Provider Name | Carl Seger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699957308 PECOS PAC ID: 1951455773 Enrollment ID: I20230404002625 |
| Provider Name | Jeremy Stich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295027126 PECOS PAC ID: 7416133616 Enrollment ID: I20230406002185 |
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