Healthcare Provider Details

I. General information

NPI: 1962456145
Provider Name (Legal Business Name): WRIGHTSBORO FAMILY PRACTICE AND URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2539 CASTLE HAYNE RD STE F1
WILMINGTON NC
28401-2691
US

IV. Provider business mailing address

2539 CASTLE HAYNE RD STE F1
WILMINGTON NC
28401-2691
US

V. Phone/Fax

Practice location:
  • Phone: 910-392-7064
  • Fax: 910-392-5885
Mailing address:
  • Phone: 910-392-7064
  • Fax: 910-392-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES JEROME PENCE JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 910-392-7064