Healthcare Provider Details

I. General information

NPI: 1245807056
Provider Name (Legal Business Name): MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 ELTON WAY STE 105
GREENSBORO NC
27406-8973
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 336-860-0981
  • Fax: 336-907-4714
Mailing address:
  • Phone: 919-341-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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