NPIMap

Organization Active NPI

Med First Immediate Care & Family Practice PA

  • Family Medicine Physician
  • Southport, NC
National Provider Identifier
1821518564
Registry record updated Jan 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA
Practice address
5130 Southport Supply Rd SE Ste 101
Southport, NC 28461-9262
Phone
(910) 269-2053
Fax
(910) 363-4905
NPI assigned
Jun 23, 2017
Last updated
Jan 21, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2020

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

Authorized official

Name
Mr. Paul Feneck
Title
Chief Executive Officer
Phone
(919) 341-4016

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

5130 Southport Supply Rd SE Ste 101
Southport, NC 28461-9262

Mailing address

1616 E Millbrook Rd Ste 110
Raleigh, NC 27609-4971
Phone (919) 341-4016

National Provider Directory

National Provider Directory
Tax ID family
Med First Immediate Care F44 organizations share this tax ID, including this one
Part of
Med First Immediate Care F

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1498176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1821518564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 E MILLBROOK RD STE 110",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276094971",
            "telephone_number": "919-341-4016",
            "fax_number": "910-346-1907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5130 SOUTHPORT SUPPLY RD SE STE 101",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284619262",
            "telephone_number": "910-269-2053",
            "fax_number": "910-363-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA",
        "enumeration_date": "2017-06-23",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "FENECK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "919-341-4016",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southport, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; 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.