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NPI Code Detail

MEDICARE: LITTLE RIVER MED 1 PA

MEDICARE: LITTLE RIVER MED 1 PA
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
1207Q00000XFamily Medicine Physician28928NC

General Provider Information

NPI Number : 1467619817
Entity Type Code : Organization
Provider Name (Legal Business Name) : LITTLE RIVER MED 1 PA
Provider Business Mailing Address
First Line : 210 N HERMAN ST
Second Line :
City : GOLDSBORO
State : NC
Zip : 27530-3810
Country : US
Telephone Number : 919-736-0767
Fax Number : 919-580-0148
Provider Business Practice Location Address
First Line : 210 N HERMAN ST
Second Line :
City : GOLDSBORO
State : NC
Zip : 27530-3810
Country : US
Telephone Number : 919-736-0767
Fax Number : 919-580-0148
Authorized Official
Title or Position : PRESIDENT
Name : DR. CLEMENT L MCCASKILL
Credential : D.O.
Telephone Number : 919-736-0767
Provider Enumeration Date : 05/21/2008
Last Update Date : 11/04/2010

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Directions to “LITTLE RIVER MED 1 PA ” Practice Location

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