Healthcare Provider Details

I. General information

NPI: 1023851144
Provider Name (Legal Business Name): MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10620 PARK RD STE 128
CHARLOTTE NC
28210-0106
US

IV. Provider business mailing address

1616 E MILLBROOK RD STE 110
RALEIGH NC
27609-4971
US

V. Phone/Fax

Practice location:
  • Phone: 704-542-6111
  • Fax: 704-542-1239
Mailing address:
  • Phone: 919-341-4016
  • Fax: 919-977-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL HUGHES
Title or Position: CREDENTIALING
Credential:
Phone: 919-341-4016