MEDICARE: RAMSEY NORTH MEDICAL CLINIC, P.A.

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	9500382	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50347	OTHER	NC	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1386821833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMSEY NORTH MEDICAL CLINIC, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 87768
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-7768
Country	:	US
Telephone Number	:	910-670-5596
Fax Number	:

Provider Business Practice Location Address
First Line	:	5603 RAMSEY ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-1423
Country	:	US
Telephone Number	:	910-670-5596
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KALPANA ANANTHA KRISHNA
Credential	:	M.D.
Telephone Number	:	910-670-5596

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	08/22/2008

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