Healthcare Provider Details

I. General information

NPI: 1750610960
Provider Name (Legal Business Name): FEDERAL BUREAU OF PRISONS
Entity Type: Organization
Gender:
Sole Proprietor:

Provider Other Name: FEDERAL MEDICAL CENTER BUTNER

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OLD HWY 75
BUTNER NC
27509
US

IV. Provider business mailing address

PO BOX 1600
BUTNER NC
27509-4600
US

V. Phone/Fax

Practice location:
  • Phone: 919-575-3900
  • Fax: 919-575-4821
Mailing address:
  • Phone: 919-575-3900
  • Fax: 919-575-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS DUCHESNE
Title or Position: CLINICAL DIRECTOR
Credential: M.D.
Phone: 919-575-3900