Tar River Mission Clinic, Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

TAR RIVER MISSION CLINIC, INC.

Practice address

1041 Noell LN
Medical Plaza B
Rocky Mount, NC 27804-2058

Phone

(252) 962-3450

Fax

(252) 962-3451

NPI assigned

Feb 11, 2013

Organization subpart

No

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

Authorized official

Name

Gene Wilson

Title

Executive Director

Phone

(252) 962-3455

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1360540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360540800000",
    "number": "1649519612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 NOELL LN",
            "address_2": "MEDICAL PLAZA B",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278042058",
            "telephone_number": "252-962-3450",
            "fax_number": "252-962-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 NOELL LN",
            "address_2": "MEDICAL PLAZA B",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278042058",
            "telephone_number": "252-962-3450",
            "fax_number": "252-962-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAR RIVER MISSION CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-11",
        "last_updated": "2013-02-11",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "GENE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "252-962-3455"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connor Thomas Tabak, BCBA
• Gloria Lashanda Tabron, FNP
• Tonique Tabron, FNP-BC
• Olivia Talarico, PA
• Deborah Tang
• Patricia Tavaziva, NP
• Braxton Joshua Taylor, MSW, LCSWA
• Drue Miller Taylor, PHYSICAL THERAPIST
• Mary Allison Taylor, PA
• Tevin Linear Taylor, DPT

• Primary Care Clinic/Center in Rocky Mount, NC
• Providers in Rocky Mount, NC by specialty
• Primary Care Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2013; 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.