Bunn Medical Center PA
Organization Active NPI Family Medicine Physician · Bunn, NC
NPI 1366528358 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1366528358
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 68505 (NC)
- Legal business name
- BUNN MEDICAL CENTER PA
- Practice address
- 285 Main Street
Bunn, NC 27508-0368 - Phone
- (919) 496-6511
- Fax
- (919) 496-2889
- NPI assigned
- Oct 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Dhruva Kumar, MD
- Title
- President
- Phone
- (919) 496-6511
Practitioners 3
-
Vanessa Marie Brosan, FNP-C
-
Dhruva Kumar, MD
-
Stacy Drew, PA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0899975 | Bunn Medical Center, PA | Certificate of waiver | Apr 12, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100121000358 | NC | Part B Supplier - Clinic/Group Practice | 8224170790 |
Receives reassigned benefits from 3 practitioners Practice locations: Bunn, NC |
National Provider Directory
Locations
285 Main St
Bunn, NC 27508
Phone (919) 496-6511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 68505 | NC | Yes |
Addresses
Primary practice location
285 Main Street
Bunn, NC 27508-0368
Mailing address
285 Main Street
Bunn, NC 27508-0368
Phone (919) 496-6511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 890186N | Medicaid | NC |
Other providers in Bunn, NC
- Bunn Primary Care PLLC
- Cletus Helms Simpson, DDS PA
- Corner Drug Stores Inc
- Stacy Drew
- Shawn Anil Dua
All providers in Bunn, NC · Family 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 Aug 22, 2020. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.