Wilmington Primary Care, Pa | |
1990 S 16th St Wilmington NC 28401-6647 | |
(910) 762-7071 | |
(910) 762-9658 |
Full Name | Wilmington Primary Care, Pa |
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Speciality | Internal Medicine |
Location | 1990 S 16th St, Wilmington, North Carolina |
Authorized Official Name and Position | Fred H Van Nynatten (OWNER) |
Authorized Official Contact | 9107627071 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Wilmington Primary Care, Pa 1990 S 16th St Wilmington NC 28401-6647 Ph: (910) 762-7071 | Wilmington Primary Care, Pa 1990 S 16th St Wilmington NC 28401-6647 Ph: (910) 762-7071 |
NPI Number | 1881819407 |
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Provider Enumeration Date | 04/17/2007 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 0840343687 |
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Medicare Enrollment ID | O20090727000774 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881819407 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 19777 (North Carolina) | Primary |
Provider Name | Fred H Van Nynatten |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1811076714 PECOS PAC ID: 7113070954 Enrollment ID: I20090727000771 |
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