| Organization Name: | MEDAC HEALTH SERVICES, PA |
| NPI Number: | 1114100872 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL PAUL MOULTON (PRESIDENT) |
| Mailing Address: | 8115 Market St Suite 100 Wilmington |
| State: | NC US |
| Postal Code: | 284118427 |
| Phone Number: | 9106861972 |
| Fax Number: | 9103321072 |
| NPI Enumeration Date: | 12/17/2007 |
| NPI Last Update Date: | 05/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 15811 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |