MEDICARE: NC DEPT OF PUBLIC SAFETY

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	251K00000X	Public Health or Welfare Agency	0010-05558	NC

General Provider Information

NPI Number	:	1295275170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NC DEPT OF PUBLIC SAFETY

Provider Business Mailing Address
First Line	:	PO BOX 215
Second Line	:
City	:	MAURY
State	:	NC
Zip	:	28554-0215
Country	:	US
Telephone Number	:	252-747-8101
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 US 903 N
Second Line	:
City	:	MAURY
State	:	NC
Zip	:	28554
Country	:	US
Telephone Number	:	252-747-8101
Fax Number	:

Authorized Official
Title or Position	:	DEPUTY MEDICAL DIRECTOR
Name	:	ABHAY AGARWAL
Credential	:	MD
Telephone Number	:	984-255-6061

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/27/2017

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Directions to “NC DEPT OF PUBLIC SAFETY ” Practice Location

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