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General NPI Number Information
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NPI Number | 1518014901
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Entity Type | Organization
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Legal Business Name | LUMBERTON MEDICAL CLINIC, P.A.
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 395 W 27TH ST
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City | LUMBERTON
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State | NC
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Zip | 28358-3018
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Country | US
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Telephone | 910-739-7551
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Fax | 910-739-2332
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Provider Business Mailing Address
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Address Line | 395 W 27TH ST
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City | LUMBERTON
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State | NC
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Zip | 28358-3018
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Country | US
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Telephone | 910-739-7551
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Fax | 910-739-2332
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | WANDA P BODIFORD
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Credential |
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Telephone | 910-739-7551
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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 | 40303
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License Number State | NC
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