Independence Medical, PA
Organization Active NPI Geriatric Medicine (Family Medicine) Physician · Smithfield, NC
NPI 1700845112 · NPPES record last updated Oct 31, 2013
Key facts
- NPI
- 1700845112
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Geriatric Medicine (Family Medicine) Physician 207QG0300X
- License
- 36493 (NC)
- Legal business name
- INDEPENDENCE MEDICAL, PA
- Practice address
- 515 Barbour Rd
Smithfield, NC 27577-7698 - Phone
- (919) 544-4747
- Fax
- (919) 544-0104
- NPI assigned
- Mar 23, 2006
- Organization subpart
- No
Authorized official
- Name
- Bernard L Bennett, M.D.
- Title
- President
- Phone
- (919) 622-8272
Practitioners 14
-
Karen Brown Jones, FNP-C
-
Theresa S Clarke, PA
-
Mars F Davis, PA-C
-
Cameron Hardee, A.N.P
-
Dwan Kelsey, NP
-
Patricia J Riley, ARNP, BC
-
Marlyn C Teague, NP
-
Hong Yu, M.D.
-
Shivanthi Ponniah, FNP
National Provider Directory
Locations
321 E Carver St
Durham, NC 27704
Phone (919) 471-3558
3909 Sunset Ridge Rd
Ste 130
Raleigh, NC 27607
Phone (919) 544-4747
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician |
207QG0300X | 36493 | NC | Yes |
Addresses
Primary practice location
515 Barbour Rd
Smithfield, NC 27577-7698
Mailing address
1209 Falls Bridge Dr
Raleigh, NC 27614-8935
Phone (919) 544-4747
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DA5493 | Other | NC | MEDICARE RAILROAD |
| 891028P | Medicaid | NC | |
| 1028P | Medicaid | NC | |
| P00062870 | Other | NC | MEDICARE RAILROAD |
Other providers in Smithfield, NC
- Isobelle Hughes
- Timothy Richard Hughes
- Jada Hunter
- Kafui Adzena Hunu
- Independence Health PA
- Integrasleep LLC
- Integrative Wellness Partners, Inc
- Brittany Evans Jackson
- Susan K Jackson
- Shaquirah Selina Jacques
All providers in Smithfield, NC · Geriatric Medicine (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 Oct 31, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.