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NPI Code Detail

MEDICARE: FIRST FOUNDATION CLINIC OF THE CAROLINAS, INC.

MEDICARE: FIRST FOUNDATION CLINIC OF THE CAROLINAS, INC.
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
1207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10233UOTHERNCBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912968934
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIRST FOUNDATION CLINIC OF THE CAROLINAS, INC.
Provider Business Mailing Address
First Line : PO BOX 578
Second Line :
City : DALLAS
State : NC
Zip : 28034-0578
Country : US
Telephone Number : 704-923-0446
Fax Number : 704-923-8319
Provider Business Practice Location Address
First Line : 107 N SUMMEY ST
Second Line :
City : DALLAS
State : NC
Zip : 28034-1824
Country : US
Telephone Number : 704-923-0446
Fax Number : 704-923-8319
Authorized Official
Title or Position : OFFICE MANAGER
Name : MS. THIRRFERN JAMERSON
Credential :
Telephone Number : 704-923-0446
Provider Enumeration Date : 03/29/2006
Last Update Date : 08/22/2008

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