MEDICARE: CLINTON X-RAY ASSOCIATES, PA

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	2085R0202X	Diagnostic Radiology Physician		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0122G	OTHER	NC	BCBS OF NC

General Provider Information

NPI Number	:	1174521330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON X-RAY ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	PO BOX 619
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28329-0619
Country	:	US
Telephone Number	:	910-592-8070
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 COOPER DR
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-2817
Country	:	US
Telephone Number	:	910-592-8070
Fax Number	:	910-592-8549

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GORDON ROBERTS MCDEVITT JR.
Credential	:	MD
Telephone Number	:	910-592-8070

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/13/2023

Similar Medicare Providers

1073511234 — GORDON ROBERTS MCDEVITT JR. MD
Practice Location Address:

409C COOPER DR
CLINTON, NC
28328-2817

Practice Phone: 910-592-8070
Practice Fax: 910-592-8549

1265430425 — DR. ROLF PETER GOBIEN M.D.
Practice Location Address:

409C COOPER DR
CLINTON, NC
28328-2817

Practice Phone: 910-592-8070
Practice Fax: 910-592-8549

1033152806 — DR. WENDY RENEE PAVKOV-POPOW D.C.
Practice Location Address:

401 COOPER DR
CLINTON, NC
28328-2817

Practice Phone: 910-592-2250
Practice Fax:

1396753646 — DR. TIMOTHY MARK KOSTERMAN D.C.
Practice Location Address:

401 COOPER DR
CLINTON, NC
28328-2817

Practice Phone: 910-592-2250
Practice Fax: 910-592-6143

1316136823 — DR. WESLEY DALE MOORE D.C.
Practice Location Address:

405 COOPER DR
CLINTON, NC
28328-2817

Practice Phone: 910-592-8848
Practice Fax:

1356491666 — DR. JOHN C. PRYSE,JR. DDS
Practice Location Address:

180 EDGEWOOD AVE
CLINTON, TN
37716-2817

Practice Phone: 865-457-2299
Practice Fax: 865-463-8223

Directions to “CLINTON X-RAY ASSOCIATES, PA ” Practice Location

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