| Eagle Medical Center | |
|
6005 Hickory Grove Road Charlotte NC 28215-5104 | |
| (704) 945-6480 | |
| (704) 926-5439 |
| Full Name | Eagle Medical Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 6005 Hickory Grove Road, Charlotte, North Carolina |
| Authorized Official Name and Position | Lhynne Lesko (BUSINESS ADMINISTRATOR) |
| Authorized Official Contact | 7049345434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle Medical Center 6005 Hickory Grove Road Charlotte NC 28215 Ph: (704) 945-6480 | Eagle Medical Center 6005 Hickory Grove Road Charlotte NC 28215-5104 Ph: (704) 945-6480 |
| NPI Number | 1487942314 |
|---|---|
| Provider Enumeration Date | 07/12/2011 |
| Last Update Date | 12/22/2011 |
| Medicare PECOS PAC ID | 0143360750 |
|---|---|
| Medicare Enrollment ID | O20191122001967 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487942314 | NPI | - | NPPES |
| 14096 | Other | NC | BLUECROSS BLUESHIELD |
| 5913081 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 200501333 (North Carolina) | Primary |
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