Mt. Olive Family Medicine Center

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

9801525 Issued in NC

Legal business name

MT. OLIVE FAMILY MEDICINE CENTER

Practice address

201 N Breazeale Ave
Mount Olive, NC 28365-1603

Phone

(919) 658-4954

NPI assigned

Feb 26, 2010

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

Sr. Director of Operations

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

Part of

Tri - State Medical Group Inc

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Ashford Blizzard, FNP

  • Adult Medicine Physician
  • Goldsboro, NC
  • NPI 1043945041
  NPD
• Vincent Paul Wilson, M.D.

  • Family Medicine Physician
  • Mount Olive, NC
  • NPI 1609820463
  NPD

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

{
    "created_epoch": "1267142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350950400000",
    "number": "1639491038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N BREAZEALE AVE",
            "city": "MOUNT OLIVE",
            "state": "NC",
            "postal_code": "283651603",
            "telephone_number": "919-658-4954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. OLIVE FAMILY MEDICINE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2010-02-26",
        "last_updated": "2012-10-23",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "SR. DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NC",
            "license": "9801525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Massoud Motamed, D.C.
• Shanta Motamed, DC
• Mount Olive Physical Therapy LLC
• Mt Olive Family Medicine Center Inc
• Mt. Olive Chiropractic Clinic, P.C.
• Javier Murillo
• Catherine F Noonan, LCSW
• Nova Ic, Inc.
• Yajaira Lynn Elizabeth Oneill
• Matthew Parker, M.A., LAT, ATC

• Non-Pharmacy Dispensing Site in Mount Olive, NC
• Providers in Mount Olive, NC by specialty
• Non-Pharmacy Dispensing Site in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; 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.