Provider Demographics
NPI:1194893487
Name:CREEDMOOR CENTRE MEDICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:CREEDMOOR CENTRE MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:JUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-383-9286
Mailing Address - Street 1:8311 BANDFORD WAY
Mailing Address - Street 2:SUITE 007
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2756
Mailing Address - Country:US
Mailing Address - Phone:919-390-0400
Mailing Address - Fax:919-390-0401
Practice Address - Street 1:8311 BANDFORD WAY
Practice Address - Street 2:SUITE 007
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2756
Practice Address - Country:US
Practice Address - Phone:919-390-0400
Practice Address - Fax:919-390-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29127261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC84805Medicare UPIN