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NPI Code Detail

MEDICARE: MT OLIVE FAMILY MEDICINE CENTER INC

MEDICARE: MT OLIVE FAMILY MEDICINE CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1467481762
Entity Type Code : Organization
Provider Name (Legal Business Name) : MT OLIVE FAMILY MEDICINE CENTER INC
Provider Business Mailing Address
First Line : 201 N BREAZEALE AVE
Second Line :
City : MOUNT OLIVE
State : NC
Zip : 28365-1603
Country : US
Telephone Number : 919-658-4954
Fax Number : 919-658-5754
Provider Business Practice Location Address
First Line : 201 N BREAZEALE AVE
Second Line :
City : MOUNT OLIVE
State : NC
Zip : 28365-1603
Country : US
Telephone Number : 919-658-4954
Fax Number : 919-658-5754
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : CAROL DUNN DILDA
Credential :
Telephone Number : 919-581-4960
Provider Enumeration Date : 07/01/2006
Last Update Date : 12/18/2012

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Directions to “MT OLIVE FAMILY MEDICINE CENTER INC ” Practice Location

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