Provider Demographics
NPI:1699273219
Name:PRIMARY & IMMEDIATE CARE OF THE PINES, LLC
Entity type:Organization
Organization Name:PRIMARY & IMMEDIATE CARE OF THE PINES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-716-0099
Mailing Address - Street 1:211 BONNIE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-3125
Mailing Address - Country:US
Mailing Address - Phone:910-716-0099
Mailing Address - Fax:
Practice Address - Street 1:211 BONNIE BROOK RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315
Practice Address - Country:US
Practice Address - Phone:910-716-0099
Practice Address - Fax:910-405-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty