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General NPI Number Information
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NPI Number | 1720138571
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Entity Type | Organization
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Legal Business Name | WEST PRIMARY CARE, INC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 102 LIVERMORE DR
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City | PEMBROKE
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State | NC
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Zip | 28372-7270
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Country | US
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Telephone | 910-521-8484
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Fax | 910-521-9765
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Provider Business Mailing Address
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Address Line | 102 LIVERMORE DR
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City | PEMBROKE
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State | NC
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Zip | 28372-7270
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Country | US
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Telephone | 910-521-8484
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Fax | 910-521-9765
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIRSTEN L JACOBS
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Credential |
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Telephone | 910-521-8484
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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 | 9901355
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License Number State | NC
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