Healthcare Provider Details

I. General information

NPI: 1871585786
Provider Name (Legal Business Name): HIGHLAND-VALLEY PEDIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 WALTER REED RD
FAYETTEVILLE NC
28304-4437
US

IV. Provider business mailing address

PO BOX 41209
FAYETTEVILLE NC
28309-1209
US

V. Phone/Fax

Practice location:
  • Phone: 910-609-4946
  • Fax: 910-609-5407
Mailing address:
  • Phone: 910-609-6448
  • Fax: 910-609-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0213
License Number StateNC

VIII. Authorized Official

Name: MR. RICHARD H PARKS
Title or Position: CEO
Credential:
Phone: 910-609-6700