Healthcare Provider Details

I. General information

NPI: 1811177587
Provider Name (Legal Business Name): R.S. MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N PLEASANT COATS RD
BENSON NC
27504-7651
US

IV. Provider business mailing address

411 N PLEASANT COATS RD
BENSON NC
27504-7651
US

V. Phone/Fax

Practice location:
  • Phone: 919-989-4051
  • Fax: 919-989-4053
Mailing address:
  • Phone: 919-989-4051
  • Fax: 919-989-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number200000065
License Number StateNC

VIII. Authorized Official

Name: DR. REVELLA B HARMON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 919-989-4051