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NPI Code Detail

MEDICARE: PROSOURCE THERAPEUTICS

MEDICARE: PROSOURCE THERAPEUTICS
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1659530145
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROSOURCE THERAPEUTICS
Provider Business Mailing Address
First Line : 102 FOX HAVEN DR STE A
Second Line :
City : GREENVILLE
State : NC
Zip : 27858-9720
Country : US
Telephone Number : 252-353-7028
Fax Number :
Provider Business Practice Location Address
First Line : 2920 TRENT RD
Second Line :
City : NEW BERN
State : NC
Zip : 28562-2030
Country : US
Telephone Number : 252-672-8806
Fax Number :
Authorized Official
Title or Position : OWNER
Name : FELICIA SMITH
Credential :
Telephone Number : 252-353-7025
Provider Enumeration Date : 06/09/2008
Last Update Date : 03/19/2009

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Directions to “PROSOURCE THERAPEUTICS ” Practice Location

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