Organization Name: | ROXBORO MEDACCESS PRIMARY CARE |
NPI Number: | 1154559581 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAN PHILLIPS (MEMBER MANAGER) |
Mailing Address: | 3762 Durham Road Roxboro |
State: | NC US |
Postal Code: | 27573 |
Phone Number: | 3363300400 |
Fax Number: | 3363300031 |
NPI Enumeration Date: | 06/24/2009 |
NPI Last Update Date: | 06/24/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 158222 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |