Vanceboro Internal Medicine PA
Organization Active NPI Internal Medicine Physician · Vanceboro, NC
NPI 1306046875 · NPPES record last updated Jul 23, 2007
Key facts
- NPI
- 1306046875
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 9601712 (NC)
- Legal business name
- VANCEBORO INTERNAL MEDICINE PA
- Practice address
- 260 NC Highway 43
Vanceboro, NC 28586-8906 - Phone
- (252) 244-4700
- Fax
- (252) 244-4702
- NPI assigned
- Jul 23, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Carol Ann Brinson, CPC
- Title
- Medical Billing Supervisor
- Phone
- (252) 672-7730
Practitioners 2
-
Baleigh Sawyer Roach, FNP-C
-
Gurinder Paul Sandhu, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120105000058 | NC | Part B Supplier - Clinic/Group Practice | 7416123906 |
Receives reassigned benefits from 2 practitioners Practice locations: Vanceboro, NC |
National Provider Directory
Locations
260 NC Highway 43
Vanceboro, NC 28586
Phone (252) 244-4700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 9601712 | NC | Yes |
Addresses
Primary practice location
260 NC Highway 43
Vanceboro, NC 28586-8906
Mailing address
260 NC Highway 43
Vanceboro, NC 28586-8906
Phone (252) 244-4700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1106L | Other | NC | NORTH CAROLINA BCBS |
| 891106L | Medicaid | NC |
Other providers in Vanceboro, NC
- Baleigh Sawyer Roach
- Gurinder Paul Sandhu
- Shelley Denise Burgess Stallings
- The Shepard'S Joy Inc
- Megan Trask
- Robin Angela Wilson
- Wilson'S Home Care Agency, Inc.
All providers in Vanceboro, NC · Internal Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.