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General NPI Number Information
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NPI Number | 1134460892
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Entity Type | Organization
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Legal Business Name | OBXMD, P.C.
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 4721 N CROATAN HWY
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City | KITTY HAWK
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State | NC
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Zip | 27949-8912
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Country | US
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Telephone | 252-256-7792
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Fax | 252-256-7691
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Provider Business Mailing Address
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Address Line | 4721 N CROATAN HWY
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City | KITTY HAWK
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State | NC
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Zip | 27949-8912
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Country | US
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Telephone | 252-256-7792
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAREN A SUPAN-MCPHERSON
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Credential | M.D.
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Telephone | 252-256-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 2005-01853
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License Number State | NC
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