Organization Name: | PINE RIDGE OF PITTSBORO PRIMARY CARE LLC |
NPI Number: | 1194196683 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FRANKLIN HARGETT (VP OPERATIONS) |
Mailing Address: | 628-b Highway 64 East Pittsboro |
State: | NC US |
Postal Code: | 27312 |
Phone Number: | 9195424550 |
Fax Number: | |
NPI Enumeration Date: | 10/09/2015 |
NPI Last Update Date: | 10/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 1471502 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |