| Wintergreen Medical Center, Pllc | |
|
324a Beacon Dr Winterville NC 28590-7956 | |
| (252) 551-5595 | |
| (252) 321-7762 |
| Full Name | Wintergreen Medical Center, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 324a Beacon Dr, Winterville, North Carolina |
| Authorized Official Name and Position | Leland Calvin Ellis (OWNER) |
| Authorized Official Contact | 2525515595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wintergreen Medical Center, Pllc 324-a Beacon Dr Winterville NC 28590-7956 Ph: (252) 551-5595 | Wintergreen Medical Center, Pllc 324a Beacon Dr Winterville NC 28590-7956 Ph: (252) 551-5595 |
| NPI Number | 1225238009 |
|---|---|
| Provider Enumeration Date | 07/20/2007 |
| Last Update Date | 02/18/2016 |
| Medicare PECOS PAC ID | 2365539582 |
|---|---|
| Medicare Enrollment ID | O20071103000103 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225238009 | NPI | - | NPPES |
| 8976432 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 141455 (North Carolina) | Primary |
| Provider Name | Marshall Craig Simpson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841366291 PECOS PAC ID: 9638171416 Enrollment ID: I20070207000359 |
| Provider Name | Carol Gates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215419825 PECOS PAC ID: 3072859396 Enrollment ID: I20190108001566 |
Hicks Chiropractic, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 610 Old Tar Village Rd Ste E, Winterville, NC 28590 Phone: 252-215-0990 | |
Physicians East, Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4796 Old Tar Rd, Winterville, NC 28590 Phone: 252-353-4111 Fax: 252-353-1727 |