Healthcare Provider Details

I. General information

NPI: 1649399528
Provider Name (Legal Business Name): LEICESTER MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 NEW LEICESTER HWY SUITE A
ASHEVILLE NC
28806
US

IV. Provider business mailing address

304 NEW LEICESTER HWY SUITE A
ASHEVILLE NC
28806
US

V. Phone/Fax

Practice location:
  • Phone: 828-255-4723
  • Fax: 828-255-4726
Mailing address:
  • Phone: 828-255-4723
  • Fax: 828-255-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: MS. SUSAN WYNN PETERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 828-255-4723