MEDICARE: PROMED PRIMARY AND EXPRESS CARE PLLC

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
1	208D00000X	General Practice Physician	199863	NC

General Provider Information

NPI Number	:	1598181885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMED PRIMARY AND EXPRESS CARE PLLC

Provider Business Mailing Address
First Line	:	18504 HAMMOCK LN
Second Line	:
City	:	DAVIDSON
State	:	NC
Zip	:	28036-8839
Country	:	US
Telephone Number	:	704-564-9491
Fax Number	:

Provider Business Practice Location Address
First Line	:	7004 SMITH CORNERS BLVD
Second Line	:	STE A
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3793
Country	:	US
Telephone Number	:	704-688-9650
Fax Number	:	704-688-9651

Authorized Official
Title or Position	:	MANAGER/MEMBER
Name	:	DR. DANIEL P SEWARD
Credential	:
Telephone Number	:	704-564-9491

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	03/11/2014

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