| Coastal Carolina Internal Medicine, Pa | |
|
2420 Henderson Dr Jacksonville NC 28546-5254 | |
| (910) 937-0008 | |
| (910) 937-0098 |
| Full Name | Coastal Carolina Internal Medicine, Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 2420 Henderson Dr, Jacksonville, North Carolina |
| Authorized Official Name and Position | Mitzi M Ros (OFFICE MANAGER) |
| Authorized Official Contact | 9109370008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Carolina Internal Medicine, Pa 2420 Henderson Dr Jacksonville NC 28546-5254 Ph: (910) 937-0008 | Coastal Carolina Internal Medicine, Pa 2420 Henderson Dr Jacksonville NC 28546-5254 Ph: (910) 937-0008 |
| NPI Number | 1881619740 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 10/30/2019 |
| Medicare PECOS PAC ID | 7517935042 |
|---|---|
| Medicare Enrollment ID | O20040922000245 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881619740 | NPI | - | NPPES |
| 8913181 | Medicaid | NC | |
| 13181 | Other | NC | BCBS OF NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 200200443 (North Carolina) | Primary |
| Provider Name | Jose Ros |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356301634 PECOS PAC ID: 0648248179 Enrollment ID: I20101021000715 |
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