MEDICARE: POWELLS MEDICAL FACILITY

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	170100000X	Ph.D. Medical Genetics	223962	NC

General Provider Information

NPI Number	:	1285740142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POWELLS MEDICAL FACILITY

Provider Business Mailing Address
First Line	:	PO BOX 988
Second Line	:
City	:	ROSEBORO
State	:	NC
Zip	:	28382-0988
Country	:	US
Telephone Number	:	910-525-4062
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W CLINTON ST
Second Line	:
City	:	ROSEBORO
State	:	NC
Zip	:	28382
Country	:	US
Telephone Number	:	910-525-4062
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TERESA POWELL
Credential	:
Telephone Number	:	910-525-4062

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	04/29/2008

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