MEDICARE: SHIPYARD MEDICAL CENTER

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	NC 102817	NC

General Provider Information

NPI Number	:	1609918937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIPYARD MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2632 CAROLINA BEACH RD
Second Line	:	SUITE C
City	:	WILMINGTON
State	:	NC
Zip	:	28412-1806
Country	:	US
Telephone Number	:	919-931-0490
Fax Number	:	910-796-1177

Provider Business Practice Location Address
First Line	:	2632 CAROLINA BEACH RD
Second Line	:	SUITE C
City	:	WILMINGTON
State	:	NC
Zip	:	28412-1806
Country	:	US
Telephone Number	:	919-931-0490
Fax Number	:	910-796-1177

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BETTY G. MACKIE
Credential	:
Telephone Number	:	919-931-0490

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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