Healthcare Provider Details

I. General information

NPI: 1548565153
Provider Name (Legal Business Name): MONTGOMERY COUNTY PRIMARY CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CAMPUS AVENUE
RAEFORD NC
28376-2606
US

IV. Provider business mailing address

PO BOX 843145
BOSTON MA
02284-3145
US

V. Phone/Fax

Practice location:
  • Phone: 910-875-9087
  • Fax: 910-875-4597
Mailing address:
  • Phone: 866-265-7922
  • Fax: 617-402-1099

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: STUART G VOELPEL
Title or Position: COO
Credential:
Phone: 910-715-2261