Provider Demographics
NPI:1982885901
Name:NATIONAL MEDICAL CLINIC OF LINCOLNTON, PA
Entity type:Organization
Organization Name:NATIONAL MEDICAL CLINIC OF LINCOLNTON, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IFEANYICHUKWU
Authorized Official - Middle Name:OBIORA
Authorized Official - Last Name:OKAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-748-9949
Mailing Address - Street 1:105 DAVE WARLICK DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-4411
Mailing Address - Country:US
Mailing Address - Phone:704-748-9949
Mailing Address - Fax:704-748-2345
Practice Address - Street 1:105 DAVE WARLICK DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4411
Practice Address - Country:US
Practice Address - Phone:704-748-9949
Practice Address - Fax:704-748-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
NC200200150261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132W6Medicaid