Healthcare Provider Details

I. General information

NPI: 1639661796
Provider Name (Legal Business Name): OPPORTUNITIES INDUSTRIALIZATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 ALBEMARLE AVENUE
ROCKY MOUNT NC
27801
US

IV. Provider business mailing address

PO BOX 2723
ROCKY MOUNT NC
27802-2723
US

V. Phone/Fax

Practice location:
  • Phone: 252-316-8215
  • Fax: 252-822-5065
Mailing address:
  • Phone: 252-212-3486
  • Fax: 252-212-3497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY MONK-JONES
Title or Position: BILLING MANAGER
Credential:
Phone: 252-212-3486