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304 Winecoff School Rd Concord NC 28027-4172 | |
(704) 262-7901 | |
(704) 262-7902 |
Full Name | |
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Speciality | Family Medicine |
Location | 304 Winecoff School Rd, Concord, North Carolina |
Authorized Official Name and Position | Sharon Penninger (PRACTICE MANAGER) |
Authorized Official Contact | 7042627901 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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304 Winecoff School Rd Concord NC 28027-4172 Ph: (704) 262-7901 | 304 Winecoff School Rd Concord NC 28027-4172 Ph: (704) 262-7901 |
NPI Number | 1467600379 |
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Provider Enumeration Date | 09/04/2008 |
Last Update Date | 09/06/2013 |
Medicare PECOS PAC ID | 7719115047 |
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Medicare Enrollment ID | O20140114000676 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467600379 | NPI | - | NPPES |
5950529 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Jennifer S Perry |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1952341042 PECOS PAC ID: 4587723036 Enrollment ID: I20081112000635 |
Provider Name | Jan A Van Ravesteyn |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1639119860 PECOS PAC ID: 3173683315 Enrollment ID: I20081118000826 |
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