| Kam's Corner, Llc | |
|
120 E Blue Ridge Street Stuart VA 24171 | |
| (276) 734-3421 | |
| Not Available |
| Full Name | Kam's Corner, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 E Blue Ridge Street, Stuart, Virginia |
| Authorized Official Name and Position | Tina Nicole Street (CEO) |
| Authorized Official Contact | 2767343421 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kam's Corner, Llc 1612 Faircrest Ln Greensboro NC 27406-9809 Ph: (276) 734-3421 | Kam's Corner, Llc 120 E Blue Ridge Street Stuart VA 24171 Ph: (276) 734-3421 |
| NPI Number | 1235829722 |
|---|---|
| Provider Enumeration Date | 05/09/2023 |
| Last Update Date | 05/09/2023 |
| Certification Date | 04/26/2023 |
| Medicare PECOS PAC ID | 2365963493 |
|---|---|
| Medicare Enrollment ID | O20250305003494 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235829722 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tina Nicole Street |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740872092 PECOS PAC ID: 5597156828 Enrollment ID: I20220131000696 |
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