Healthcare Provider Details

I. General information

NPI: 1750197042
Provider Name (Legal Business Name): CAPE FEAR VALLEY HEALTH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 OWEN PARK LN
FAYETTEVILLE NC
28304-3454
US

IV. Provider business mailing address

PO BOX 40908
FAYETTEVILLE NC
28309-0908
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-4733
  • Fax: 910-323-2097
Mailing address:
  • Phone: 910-615-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BARTON FISER
Title or Position: VP REVENUE CYCLE AND MANAGED CARE
Credential:
Phone: 910-615-5572