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General NPI Number Information
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NPI Number | 1205865979
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Entity Type | Organization
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Legal Business Name | EDGEWATER MEDICAL CENTER AND URGENT
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 100 S 10TH STREET
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City | LILLINGTON
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State | NC
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Zip | 27546-6690
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Country | US
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Telephone | 910-893-4111
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Fax | 910-893-9850
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Provider Business Mailing Address
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Address Line | 100 S 10TH STREET
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City | LILLINGTON
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State | NC
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Zip | 27546-6690
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Country | US
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Telephone | 910-893-4111
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Fax | 910-893-9850
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. RODOLFO C REYES
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Credential | M.D.
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Telephone | 910-893-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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