Healthcare Provider Details

I. General information

NPI: 1780916866
Provider Name (Legal Business Name): MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 DOLPHIN DR
JACKSONVILLE NC
28546-5266
US

IV. Provider business mailing address

PO BOX 686
JACKSONVILLE NC
28541-0686
US

V. Phone/Fax

Practice location:
  • Phone: 910-346-2273
  • Fax:
Mailing address:
  • Phone: 910-346-2273
  • Fax: 910-346-1907

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: MRS. RANDY SCHILSKY
Title or Position: MANAGER
Credential: D.C.
Phone: 910-346-2273