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General NPI Number Information
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NPI Number | 1699921999
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Entity Type | Organization
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Legal Business Name | MIDWAY MEDICAL CENTER, PA
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 6750 CAROLINA BLVD
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City | CLYDE
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State | NC
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Zip | 28721-7052
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Country | US
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Telephone | 828-627-2211
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Fax | 855-876-9354
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Provider Business Mailing Address
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Address Line | 6750 CAROLINA BLVD
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City | CLYDE
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State | NC
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Zip | 28721-7052
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Country | US
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Telephone | 828-627-2211
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Fax | 855-876-9354
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK E KINTER
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Credential | MD
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Telephone | 828-627-2211
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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 | 62447
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License Number State | NC
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