Healthcare Provider Details

I. General information

NPI: 1124523881
Provider Name (Legal Business Name): MEDAC HEALTH SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NEW VILLAGE WAY
WILMINGTON NC
28405-7426
US

IV. Provider business mailing address

216 CENTERVIEW DR STE 100
BRENTWOOD TN
37027-3226
US

V. Phone/Fax

Practice location:
  • Phone: 910-338-2735
  • Fax: 910-338-2740
Mailing address:
  • Phone: 910-791-0075
  • Fax: 910-791-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID MALONEY
Title or Position: CEO
Credential:
Phone: 616-656-2750