| D-pom L.l.c | |
|
2109 Saint Andrew St Ste 15a&16 Tarboro NC 27886-2149 | |
| (252) 641-5452 | |
| (252) 477-0372 |
| Full Name | D-pom L.l.c |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2109 Saint Andrew St Ste 15a&16, Tarboro, North Carolina |
| Authorized Official Name and Position | Priscilla Oates (OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 2526415452 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| D-pom L.l.c Po Box 1634 Tarboro NC 27886-1634 Ph: () - | D-pom L.l.c 2109 Saint Andrew St Ste 15a&16 Tarboro NC 27886-2149 Ph: (252) 641-5452 |
| NPI Number | 1609076942 |
|---|---|
| Provider Enumeration Date | 07/24/2007 |
| Last Update Date | 12/22/2020 |
| Certification Date | 12/22/2020 |
| Medicare PECOS PAC ID | 5294130779 |
|---|---|
| Medicare Enrollment ID | O20210820002391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609076942 | NPI | - | NPPES |
| 8301751B | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Immacula Saint Louis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356449144 PECOS PAC ID: 9234104506 Enrollment ID: I20120730000643 |
| Provider Name | Shirria D. Mccullough |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811243959 PECOS PAC ID: 9830497999 Enrollment ID: I20160406001416 |
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