Organization Active NPI

Laura Jacimore, PA

  • Radiation Oncology Physician
  • Rocky Mount, NC
National Provider Identifier
1306020912
Registry record updated Aug 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
LAURA JACIMORE, PA
Practice address
2450 Curtis Ellis Dr
Rocky Mount, NC 27804-2237
Phone
(252) 443-8947
Fax
(252) 451-3090
NPI assigned
Dec 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2021

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

Authorized official

Name
Dr. Laura Lyn Jacimore, M.D.
Title
President
Phone
(919) 971-4976

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

2450 Curtis Ellis Dr
Rocky Mount, NC 27804-2237

Mailing address

105 Monabreeze Way
Garner, NC 27529-4369
Phone (919) 773-3735

Other identifiers 1

IdentifierTypeStateIssuer
891358HMedicaidNC

National Provider Directory

National Provider Directory

Locations

2450 Curtis Ellis Dr
Rocky Mount, NC 27804
Phone (252) 443-8947

NPI Registry JSON

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629072000000",
    "number": "1306020912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MONABREEZE WAY",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275294369",
            "telephone_number": "919-773-3735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 CURTIS ELLIS DR",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278042237",
            "telephone_number": "252-443-8947",
            "fax_number": "252-451-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAURA JACIMORE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A",
        "authorized_official_last_name": "JACIMORE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-971-4976",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891358H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocky Mount, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; 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.