NPIMap

Organization Active NPI

Waccamaw Primary Care Inc

  • Medical Physician Assistant
  • Whiteville, NC
National Provider Identifier
1992010094
Registry record updated Aug 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
101710 Issued in NC
Legal business name
WACCAMAW PRIMARY CARE INC
Practice address
619 Jefferson St
Whiteville, NC 28472-3707
Phone
(910) 642-2230
NPI assigned
Aug 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2010

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

Authorized official

Name
Jeffrey Alan Clarke, PANPI 1013139096
Title
Owner
Phone
(910) 642-2230

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AM0700X 101710 NC Primary

Addresses

Primary practice location

619 Jefferson St
Whiteville, NC 28472-3707

Mailing address

PO Box 790
Whiteville, NC 28472-0790
Phone (910) 641-0400

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281571200000",
    "number": "1992010094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284720790",
            "telephone_number": "910-641-0400",
            "fax_number": "910-642-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 JEFFERSON ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284723707",
            "telephone_number": "910-642-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACCAMAW PRIMARY CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-12",
        "last_updated": "2010-08-12",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-642-2230",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "101710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2010; 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.