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4330 Collettsville Rd Collettsville NC 28611-9000 | |
(828) 754-2409 | |
(828) 754-2418 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4330 Collettsville Rd, Collettsville, North Carolina |
Authorized Official Name and Position | Thomas B Mcrary (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 8287542409 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 9 Collettsville NC 28611-0009 Ph: (828) 754-2409 | 4330 Collettsville Rd Collettsville NC 28611-9000 Ph: (828) 754-2409 |
NPI Number | 1538412739 |
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Provider Enumeration Date | 10/25/2012 |
Last Update Date | 06/05/2023 |
Medicare PECOS PAC ID | 4385651876 |
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Medicare Enrollment ID | O20150709001100 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538412739 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |