=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982428975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METROPOLITAN COMMUNITY HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2024
-----------------------------------------------------
Last Update Date | 11/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 CAROLINA AVE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27889-3571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-940-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 S MARKET ST
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27889-4952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-644-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | LAURENCE J DOBY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-644-7003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------