Provider Demographics
NPI:1386165686
Name:MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA
Entity type:Organization
Organization Name:MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FENECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-238-4228
Mailing Address - Street 1:609 RICHLANDS HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-3606
Mailing Address - Country:US
Mailing Address - Phone:910-455-7888
Mailing Address - Fax:910-455-1403
Practice Address - Street 1:609 RICHLANDS HWY STE 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-3606
Practice Address - Country:US
Practice Address - Phone:910-455-7888
Practice Address - Fax:910-455-1403
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty