Healthcare Provider Details

I. General information

NPI: 1174317069
Provider Name (Legal Business Name): CAPE FEAR VALLEY HEALTH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 FORTE RD
STEDMAN NC
28391-8522
US

IV. Provider business mailing address

PO BOX 40908
FAYETTEVILLE NC
28309-0908
US

V. Phone/Fax

Practice location:
  • Phone: 910-485-6228
  • Fax: 910-485-3311
Mailing address:
  • Phone: 910-615-6949
  • Fax: 910-615-9761

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: JOSEPH BARTON FISER
Title or Position: VP MANAGED CARE/REVENUE CYCLE
Credential:
Phone: 910-615-5572