MEDICARE: MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, 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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1861900680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA

Provider Business Mailing Address
First Line	:	1616 E MILLBROOK RD STE 110
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-4971
Country	:	US
Telephone Number	:	919-341-4016
Fax Number	:	910-346-1907

Provider Business Practice Location Address
First Line	:	4002 ELTON WAY STE 104
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-8973
Country	:	US
Telephone Number	:	336-860-0981
Fax Number	:	336-914-8307

Authorized Official
Title or Position	:	CEO
Name	:	PAUL FENECK
Credential	:
Telephone Number	:	919-341-4016

Provider Enumeration Date	:	01/15/2018
Last Update Date	:	02/05/2020

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