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General NPI Number Information
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NPI Number | 1932263720
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Entity Type | Organization
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Legal Business Name | CARDINAL CLINIC LLC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 160 PINEHURST AVE STE J
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-7078
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Country | US
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Telephone | 910-693-7777
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Fax | 910-693-1524
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Provider Business Mailing Address
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Address Line | 1540 PURDUE DR STE 200
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5510
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Country | US
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Telephone | 910-867-8889
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Fax | 910-487-3061
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Authorized Official
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Title or Position | QM COORDINATOR
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Name | TONY GARCIA
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Credential |
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Telephone | 910-864-0187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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