Healthcare Provider Details

I. General information

NPI: 1093785719
Provider Name (Legal Business Name): DOWNTOWN CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CHESTNUT ST
WILMINGTON NC
28401-3940
US

IV. Provider business mailing address

119 CHESTNUT ST
WILMINGTON NC
28401-3940
US

V. Phone/Fax

Practice location:
  • Phone: 910-762-5588
  • Fax: 910-762-5589
Mailing address:
  • Phone: 910-762-5588
  • Fax: 910-762-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number69766
License Number StateNC

VIII. Authorized Official

Name: MR. JAMES PATRICK EGERER
Title or Position: OWNER
Credential: P.A.
Phone: 910-762-5588