Healthcare Provider Details

I. General information

NPI: 1245426618
Provider Name (Legal Business Name): ROCKWELL MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E MAIN ST
ROCKWELL NC
28138-6761
US

IV. Provider business mailing address

PO BOX 1060
ROCKWELL NC
28138-1060
US

V. Phone/Fax

Practice location:
  • Phone: 704-279-7227
  • Fax: 704-279-8984
Mailing address:
  • Phone: 704-279-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number95-01366
License Number StateNC

VIII. Authorized Official

Name: JOSEPH ANDREW OLIVER III
Title or Position: FAMILY PRACTITIONER
Credential: MD
Phone: 704-279-7227