MEDICARE: RISING INTEGRATIVE HEALTHCARE, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1760003032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING INTEGRATIVE HEALTHCARE, PLLC

Provider Business Mailing Address
First Line	:	504 RED BANKS RD STE C
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5766
Country	:	US
Telephone Number	:	252-321-3579
Fax Number	:

Provider Business Practice Location Address
First Line	:	3338 WELLONS BLVD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5290
Country	:	US
Telephone Number	:	252-631-5353
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	BRIAN M KEAN
Credential	:
Telephone Number	:	252-321-3579

Provider Enumeration Date	:	04/28/2020
Last Update Date	:	08/17/2021

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