Gerald Edwin Brenneman, P.A.C.
Individual provider Active NPI Physician Assistant · Coats, NC
NPI 1649201336 · NPPES record last updated Sep 26, 2012
Key facts
- NPI
- 1649201336
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 101469 (NC)
- Practice address
- Coats Medical Clinic
25 North Johnson St.
Coats, NC 27521 - Phone
- (910) 897-6423
- Fax
- (910) 897-2540
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 101469 | NC | Yes |
Addresses
Primary practice location
Coats Medical Clinic
25 North Johnson St.
Coats, NC 27521
Mailing address
P.O. Box 819
25 North Johnson St.
Coats, NC 27521-0819
Phone (910) 897-6423
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101469 | Other | NC | STATE LICENSE NUMBER |
Other providers in Coats, NC
- Regina Braxton Bray Brown
- Cynthia Lonigan Burkes
- Cape Fear Valley Health Medical Group LLC
- Coats Grove Fire & Rescue Inc
- Coats Medical Clinic, PA
- Coats Medical Services LLC
All providers in Coats, NC · Physician Assistant 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 Sep 26, 2012. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.