Healthcare Provider Details

I. General information

NPI: 1144317470
Provider Name (Legal Business Name): BOICE WILLIS CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N WINSTEAD AVE STE 310
ROCKY MOUNT NC
27804-8467
US

IV. Provider business mailing address

PO BOX 7200
ROCKY MOUNT NC
27804-0200
US

V. Phone/Fax

Practice location:
  • Phone: 252-937-0291
  • Fax: 252-451-0056
Mailing address:
  • Phone: 252-937-0200
  • Fax: 252-451-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number38821
License Number StateNC

VIII. Authorized Official

Name: JUSTIN ADAMS
Title or Position: REVENUE CYCLE SUPERVISOR
Credential:
Phone: 252-937-0486