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NPI Code Detail

MEDICARE: MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA

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
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1942579339
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 : 4222 LONG BEACH RD SE
Second Line :
City : SOUTHPORT
State : NC
Zip : 28461-8627
Country : US
Telephone Number : 910-269-2053
Fax Number :
Authorized Official
Title or Position : CEO
Name : PAUL FENECK
Credential :
Telephone Number : 919-341-4016
Provider Enumeration Date : 12/14/2011
Last Update Date : 01/21/2020

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Directions to “MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA ” Practice Location

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