Provider Demographics
NPI:1114100872
Name:MEDAC HEALTH SERVICES, PA
Entity type:Organization
Organization Name:MEDAC HEALTH SERVICES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEA
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-656-2750
Mailing Address - Street 1:216 CENTERVIEW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3226
Mailing Address - Country:US
Mailing Address - Phone:910-791-0075
Mailing Address - Fax:615-656-2745
Practice Address - Street 1:8115 MARKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8427
Practice Address - Country:US
Practice Address - Phone:910-686-1972
Practice Address - Fax:910-686-2129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDAC HEALTH SERVICES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-17
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07651OtherBCBS
NCCC2877OtherRAILROAD MEDICARE
NCCC2877OtherRAILROAD MEDICARE
NC0529800003Medicare NSC