MEDICARE: CAPE FEAR VALLEY HEALTH MEDICAL GROUP LLC

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

General Provider Information

NPI Number	:	1114711090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE FEAR VALLEY HEALTH MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 40908
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28309-0908
Country	:	US
Telephone Number	:	910-615-6949
Fax Number	:	910-615-9761

Provider Business Practice Location Address
First Line	:	5523 WALDOS BEACH RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-5505
Country	:	US
Telephone Number	:	910-615-3120
Fax Number	:	910-615-9750

Authorized Official
Title or Position	:	VP MANAGED CARE/REVENUE CYCLE
Name	:	JOSEPH BARTON FISER
Credential	:
Telephone Number	:	910-615-5572

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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