MEDICARE: PLANNED PARENTHOOD SOUTH ATLANTIC

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	261QF0050X	Non-Surgical Family Planning Clinic/Center
2	363L00000X	Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801932199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANNED PARENTHOOD SOUTH ATLANTIC

Provider Business Mailing Address
First Line	:	100 S BOYLAN AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-1802
Country	:	US
Telephone Number	:	919-833-7534
Fax Number	:	919-833-0730

Provider Business Practice Location Address
First Line	:	522 GRAND CENTRAL AVE
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-2169
Country	:	US
Telephone Number	:	304-295-3331
Fax Number	:	304-295-4924

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE
Name	:	TEARRA ALEXANDRIA RAYNOR
Credential	:
Telephone Number	:	919-833-7526

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	05/28/2024

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Directions to “PLANNED PARENTHOOD SOUTH ATLANTIC ” Practice Location

Language	Start Address	Practice Location

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