| Cedar Creek Family Medicine Pllc | |
|
5350 S Main St Winston Salem NC 27107-9174 | |
| (336) 784-0505 | |
| Not Available |
| Full Name | Cedar Creek Family Medicine Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5350 S Main St, Winston Salem, North Carolina |
| Authorized Official Name and Position | Kimberly R Nifong (CO OWNER) |
| Authorized Official Contact | 3367840505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cedar Creek Family Medicine Pllc 5350 S Main St Winston Salem NC 27107-9174 Ph: (336) 784-0505 | Cedar Creek Family Medicine Pllc 5350 S Main St Winston Salem NC 27107-9174 Ph: (336) 784-0505 |
| NPI Number | 1952579807 |
|---|---|
| Provider Enumeration Date | 02/13/2008 |
| Last Update Date | 02/13/2008 |
| Medicare PECOS PAC ID | 4880869338 |
|---|---|
| Medicare Enrollment ID | O20111212000216 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952579807 | NPI | - | NPPES |
| 89014U9 | Medicaid | NC | |
| 014U9 | Other | OH | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 88463 (North Carolina) | Primary |
| Provider Name | Ted James Nifong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063599587 PECOS PAC ID: 0244214690 Enrollment ID: I20040615000396 |
| Provider Name | Kimberly Ragsdale |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326125840 PECOS PAC ID: 4981736618 Enrollment ID: I20100715001025 |
| Provider Name | Alexis N Fulk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043586605 PECOS PAC ID: 5294038873 Enrollment ID: I20160115000502 |
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