MEDICARE: BEACHCARE URGENT AND FAMILY MEDICAL CENTER, 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	363A00000X	Physician Assistant	103970	NC

General Provider Information

NPI Number	:	1407134323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACHCARE URGENT AND FAMILY MEDICAL CENTER, PLLC

Provider Business Mailing Address
First Line	:	5059 HWY 70 W
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4503
Country	:	US
Telephone Number	:	252-808-3696
Fax Number	:	252-808-2022

Provider Business Practice Location Address
First Line	:	5059 HWY 70 W
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4503
Country	:	US
Telephone Number	:	252-808-3696
Fax Number	:	252-808-2022

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. STEVEN DAVID RAPPAPORT
Credential	:
Telephone Number	:	252-808-3696

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	06/24/2013

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