Healthcare Provider Details

I. General information

NPI: 1831473057
Provider Name (Legal Business Name): EXPRESS CARE & FAMILY PRACTICE CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 NC HIGHWAY 125
ROANOKE RAPIDS NC
27870-6351
US

IV. Provider business mailing address

93 NC HIGHWAY 125
ROANOKE RAPIDS NC
27870-6351
US

V. Phone/Fax

Practice location:
  • Phone: 252-308-0686
  • Fax: 252-308-0729
Mailing address:
  • Phone: 252-308-0686
  • Fax: 252-308-0729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number101911
License Number StateNC

VIII. Authorized Official

Name: MR. CARLTON REID BEAMAN JR.
Title or Position: PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 252-308-0686