Healthcare Provider Details

I. General information

NPI: 1689635237
Provider Name (Legal Business Name): FIRST CARE MEDICAL CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S SUTHERLAND AVE
MONROE NC
28112-5060
US

IV. Provider business mailing address

404 S SUTHERLAND AVE
MONROE NC
28112-5060
US

V. Phone/Fax

Practice location:
  • Phone: 704-291-9267
  • Fax: 704-283-7939
Mailing address:
  • Phone: 704-291-9267
  • Fax: 704-283-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BENEDICT O OKWARA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 704-291-9267