Provider Demographics
NPI:1194124362
Name:IN-HOUSE DOC, INC
Entity type:Organization
Organization Name:IN-HOUSE DOC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:ARIZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-245-9519
Mailing Address - Street 1:935 E MOUNTAIN ST STE M
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3238
Mailing Address - Country:US
Mailing Address - Phone:336-245-9519
Mailing Address - Fax:336-245-4613
Practice Address - Street 1:1123 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5339
Practice Address - Country:US
Practice Address - Phone:336-245-9519
Practice Address - Fax:336-245-4613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001-01309174400000X, 282E00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No282E00000XHospitalsLong Term Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10991225OtherCAQH
NC89132JPMedicaid
NC10991225OtherCAQH
NC89132JPMedicaid