MEDICARE: MED MART MEDICAL ASSOCIATES PLLC

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	207R00000X	Internal Medicine Physician	9500701	NC

General Provider Information

NPI Number	:	1326217399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED MART MEDICAL ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	100 S 10TH ST
Second Line	:
City	:	LILLINGTON
State	:	NC
Zip	:	27546-6690
Country	:	US
Telephone Number	:	910-893-4111
Fax Number	:	910-893-9850

Provider Business Practice Location Address
First Line	:	7212 GB ALFORD HWY
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-7661
Country	:	US
Telephone Number	:	919-552-1520
Fax Number	:	919-552-8792

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RODOLFO C REYES
Credential	:	MD
Telephone Number	:	910-893-4111

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/09/2010

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