Provider Demographics
NPI:1124309463
Name:ROCKINGHAM MEDICAL CLINIC, P.C.
Entity type:Organization
Organization Name:ROCKINGHAM MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:CAMARGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-533-0326
Mailing Address - Street 1:101 E MATTHEWS ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5373
Mailing Address - Country:US
Mailing Address - Phone:980-339-7442
Mailing Address - Fax:980-339-5925
Practice Address - Street 1:101 E MATTHEWS ST STE 400
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5373
Practice Address - Country:US
Practice Address - Phone:980-339-7442
Practice Address - Fax:980-339-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918242Medicaid
NCA305Medicare PIN