1457647885 NPI number — MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA

Table of content: (NPI 1457647885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457647885 NPI number — MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457647885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 686
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28541-0686
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-346-2273
Provider Business Mailing Address Fax Number:
910-346-1907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7901 EMERALD DRIVE
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
EMERALD ISLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28549-2880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-354-6500
Provider Business Practice Location Address Fax Number:
252-354-5060
Provider Enumeration Date:
06/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SCHILSKY
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
910-346-2273

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com