MEDICARE: BRICK CITY PRIMARY CARE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	9700960	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G38837	OTHER	NC	UPIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003050238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRICK CITY PRIMARY CARE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 237
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27331-0237
Country	:	US
Telephone Number	:	919-776-7725
Fax Number	:	919-776-0511

Provider Business Practice Location Address
First Line	:	125 CHATHAM ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4335
Country	:	US
Telephone Number	:	919-776-7725
Fax Number	:	919-776-0511

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. DANA L GARRETT
Credential	:	M.D.
Telephone Number	:	919-776-7725

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	05/01/2009

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