Healthcare Provider Details

I. General information

NPI: 1487178588
Provider Name (Legal Business Name): MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S MAIN ST STE A
WAKE FOREST NC
27587-5011
US

IV. Provider business mailing address

1616 E MILLBROOK RD STE 110
RALEIGH NC
27609-4971
US

V. Phone/Fax

Practice location:
  • Phone: 919-570-2000
  • Fax: 919-570-2001
Mailing address:
  • Phone: 919-341-4016
  • Fax: 910-346-1907

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: MR. PAUL FENECK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 919-341-4016