NPIMap

Organization Active NPI

Med First Immediate Care & Family Practice, PA

  • Family Medicine Physician
  • Raleigh, NC
National Provider Identifier
1104578038
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA
Practice address
3396 Six Forks Rd
Raleigh, NC 27609-7233
Phone
(919) 781-8897
Fax
(919) 782-4839
NPI assigned
Jan 21, 2022
Last updated
Jan 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

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

Authorized official

Name
Mr. Paul Feneck
Title
Ceo
Phone
(919) 341-4016

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

3396 Six Forks Rd
Raleigh, NC 27609-7233

Mailing address

1616 E Millbrook Rd Ste 110
Raleigh, NC 27609-4971
Phone (919) 341-4016

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1035936Med First Immediate Care and Family Practice, PA3396 Six Forks Road, Raleigh, NC 27609Certificate of waiverMay 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Med First Immediate Care F44 organizations share this tax ID, including this one
Part of
Med First Immediate Care F

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642723200000",
    "number": "1104578038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 E MILLBROOK RD STE 110",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276094971",
            "telephone_number": "919-341-4016",
            "fax_number": "910-346-1907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3396 SIX FORKS RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097233",
            "telephone_number": "919-781-8897",
            "fax_number": "919-782-4839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA",
        "enumeration_date": "2022-01-21",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A",
        "authorized_official_last_name": "FENECK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-341-4016",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.