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General NPI Number Information
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NPI Number | 1447210976
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Entity Type | Organization
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Legal Business Name | COLUMBUS PEDIATRICS & ADOLESCENT CARE PA
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 800 JEFFERSON ST SUITE 116
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City | WHITEVILLE
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State | NC
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Zip | 28472-3710
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Country | US
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Telephone | 910-642-2642
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Fax | 910-642-3346
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Provider Business Mailing Address
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Address Line | 800 JEFFERSON ST SUITE 116
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City | WHITEVILLE
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State | NC
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Zip | 28472-3702
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Country | US
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Telephone | 910-642-2642
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Fax | 910-642-3346
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DR. COY RANDOLPH MATTHEWS
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Credential | M.D.
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Telephone | 910-642-2642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 36388
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License Number State | NC
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