Healthcare Provider Details

I. General information

NPI: 1932297751
Provider Name (Legal Business Name): LAUREL HILL MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18901 IDA MILL RD
LAUREL HILL NC
28351-8326
US

IV. Provider business mailing address

18901 IDA MILL RD
LAUREL HILL NC
28351-8326
US

V. Phone/Fax

Practice location:
  • Phone: 910-462-2707
  • Fax: 910-462-4184
Mailing address:
  • Phone: 910-462-2707
  • Fax: 910-462-4184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BHIRO
Title or Position: CORP. SECRETARY
Credential:
Phone: 910-462-2707