| Community Medical, P.a. | |
|
520 W Main St Marshville NC 28103-1197 | |
| (704) 624-3388 | |
| (704) 624-3390 |
| Full Name | Community Medical, P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 520 W Main St, Marshville, North Carolina |
| Authorized Official Name and Position | Brandi Selina Queen (PRESIDENT) |
| Authorized Official Contact | 7042920708 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Medical, P.a. 520 W Main St Marshville NC 28103-1197 Ph: (704) 624-3388 | Community Medical, P.a. 520 W Main St Marshville NC 28103-1197 Ph: (704) 624-3388 |
| NPI Number | 1396935193 |
|---|---|
| Provider Enumeration Date | 07/27/2007 |
| Last Update Date | 04/30/2024 |
| Medicare PECOS PAC ID | 7719204775 |
|---|---|
| Medicare Enrollment ID | O20150401000048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396935193 | NPI | - | NPPES |
| 890132J | Medicaid | NC | |
| 0132J | Other | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | 32725 (North Carolina) | Secondary |
| Provider Name | Gary W Henry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497778567 PECOS PAC ID: 3375548126 Enrollment ID: I20060928000574 |
| Provider Name | Brandi S Queen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558670604 PECOS PAC ID: 2769677723 Enrollment ID: I20101116000689 |
Marsville Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7204 E Marshville Blvd, Marshville, NC 28103 Phone: 704-624-9200 Fax: 704-624-9201 |