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General NPI Number Information
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NPI Number | 1962773515
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Entity Type | Organization
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Legal Business Name | EXPRESS CARE & FAMILY PRACTICE CENTER, PA
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 2080 W ARLINGTON BLVD STE A
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City | GREENVILLE
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State | NC
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Zip | 27834-3770
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Country | US
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Telephone | 252-439-0065
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Fax | 252-439-0071
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Provider Business Mailing Address
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Address Line | 2080 W ARLINGTON BLVD STE A
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City | GREENVILLE
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State | NC
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Zip | 27834-3770
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Country | US
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Telephone | 252-439-0065
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Fax | 252-439-0071
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MR. CARLTON REID BEAMAN JR.
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Credential | PHYSICIAN ASSISTANT
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Telephone | 252-439-0065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 101911
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License Number State | NC
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