Cape Fear Valley Health System Specialty Group, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

H0213 Issued in NC

Legal business name

CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC

Doing business as

Cape Fear Valley Health-the Clinic at Walmart

Practice address

4545 Fayetteville Road
Raeford, NC 28376

Phone

(910) 615-3100

Fax

(910) 486-2154

NPI assigned

Jul 15, 2010

Last updated

Jul 15, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael Nagowski

Title

Ceo

Phone

(910) 615-6700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CAPE FEAR VALLEY HEALTH-THE CLINIC AT WALMART Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279152000000",
    "number": "1083927313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283090908",
            "telephone_number": "910-615-6448",
            "fax_number": "910-615-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 FAYETTEVILLE ROAD",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "28376",
            "telephone_number": "910-615-3100",
            "fax_number": "910-486-2154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-15",
        "last_updated": "2010-07-15",
        "status": "A",
        "authorized_official_last_name": "NAGOWSKI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-615-6700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NC",
            "license": "H0213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CAPE FEAR VALLEY HEALTH-THE CLINIC AT WALMART",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Physician in Raeford, NC
• Providers in Raeford, NC by specialty
• General Practice Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.