Healthcare Provider Details

I. General information

NPI: 1801305602
Provider Name (Legal Business Name): COMPREHENSIVE MEDICAL CARE SERVICES OF EASTERN NC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COMMERCE STREET
POWELLSVILLE NC
27967
US

IV. Provider business mailing address

105 COMMERCE STREET
POWELLSVILLE NC
27967
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-6484
  • Fax: 252-332-1660
Mailing address:
  • Phone: 252-332-6484
  • Fax: 252-332-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number36700
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number36700
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. STEVEN FERGUSON
Title or Position: MEDICIAL DOCTOR
Credential: MD
Phone: 252-332-6484