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General NPI Number Information
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NPI Number | 1598148801
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Entity Type | Organization
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Legal Business Name | TRUCARE FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 4314 LUDGATE ST SUITE B
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City | LUMBERTON
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State | NC
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Zip | 28358-2461
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Country | US
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Telephone | 910-671-8766
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Fax | 910-671-8768
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Provider Business Mailing Address
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Address Line | 4314 LUDGATE ST SUITE B
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City | LUMBERTON
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State | NC
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Zip | 28358-2461
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Country | US
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Telephone | 910-671-8766
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING REP.
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Name | MRS. VERNENA OXENDINE
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Credential | CPC, CPMA
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Telephone | 910-671-8766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2011-00810
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2007-01953
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License Number State | NC
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