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General NPI Number Information
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NPI Number | 1023198728
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Entity Type | Organization
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Legal Business Name | PRIMEDOC PARK RIDGE PA
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 100 HOSPITAL DR
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City | HENDERSONVILLE
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State | NC
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Zip | 28792-5272
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Country | US
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Telephone | 843-237-3378
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Fax | 843-237-5073
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Provider Business Mailing Address
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Address Line | PO BOX 60262
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City | CHARLOTTE
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State | NC
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Zip | 28260-0262
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Country | US
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Telephone | 843-237-3378
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Fax | 843-237-5073
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | ROBERT REYNOLDS
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Credential | MD
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Telephone | 843-237-3378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N/A
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License Number State |
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