Healthcare Provider Details

I. General information

NPI: 1154815223
Provider Name (Legal Business Name): MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 RICHLANDS HWY STE 6
JACKSONVILLE NC
28540-3606
US

IV. Provider business mailing address

609 RICHLANDS HWY STE 6
JACKSONVILLE NC
28540-3606
US

V. Phone/Fax

Practice location:
  • Phone: 910-455-7888
  • Fax: 910-455-1403
Mailing address:
  • Phone: 910-455-7888
  • Fax: 910-455-1403

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: 910-346-2273