Provider Demographics
NPI:1992799308
Name:MEDICAL SPECIALISTS' CLINIC, PA
Entity type:Organization
Organization Name:MEDICAL SPECIALISTS' CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SADANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-738-1141
Mailing Address - Street 1:4384 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2677
Mailing Address - Country:US
Mailing Address - Phone:910-738-1141
Mailing Address - Fax:910-738-6011
Practice Address - Street 1:4384 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2677
Practice Address - Country:US
Practice Address - Phone:910-738-1141
Practice Address - Fax:910-738-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700753207R00000X
NC9601101207R00000X
NC25596207RC0000X
NC26135207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02142OtherBCBS
NC8902142Medicaid
NC2332945Medicare ID - Type Unspecified