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General NPI Number Information
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NPI Number | 1639460108
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Entity Type | Organization
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Legal Business Name | FIRST CARE MEDICAL CLINIC
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2450 ABERDEEN BLVD
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City | GASTONIA
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State | NC
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Zip | 28054-0644
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Country | US
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Telephone | 704-866-8030
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Fax | 704-866-8717
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Provider Business Mailing Address
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Address Line | 404 S SUTHERLAND AVE
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City | MONROE
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State | NC
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Zip | 28112-5060
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Country | US
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Telephone | 704-291-9267
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Fax | 704-283-7939
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BENEDICT O OKWARA
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Credential | MD
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Telephone | 704-291-9267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 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 #4
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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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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