MEDICARE: NORTH RALEIGH MEDICAL CENTER P.A.

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	261QP2300X	Primary Care Clinic/Center	9500164	NC
2	261QU0200X	Urgent Care Clinic/Center	9400950	NC

General Provider Information

NPI Number	:	1104883586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH RALEIGH MEDICAL CENTER P.A.

Provider Business Mailing Address
First Line	:	6729 FALLS OF NEUSE RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-5287
Country	:	US
Telephone Number	:	919-844-4344
Fax Number	:	919-844-3244

Provider Business Practice Location Address
First Line	:	6729 FALLS OF NEUSE RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-5305
Country	:	US
Telephone Number	:	919-844-4344
Fax Number	:	919-844-3244

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	MRS. KATHERINE ORTIZ BROOKS
Credential	:
Telephone Number	:	919-844-4344

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	04/04/2008

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