| Goshen Medical Center-fremont | |
|
109 S Sycamore St Fremont NC 27830-8710 | |
| (919) 242-4382 | |
| (919) 242-4526 |
| Full Name | Goshen Medical Center-fremont |
|---|---|
| Speciality | Clinic/Center |
| Location | 109 S Sycamore St, Fremont, North Carolina |
| Authorized Official Name and Position | Reba W. Futrell (EXECUTIVE ASSISTANT/CREDENTIALING) |
| Authorized Official Contact | 9102671942 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Goshen Medical Center-fremont 109 S Sycamore St Fremont NC 27830-8710 Ph: (919) 242-4382 | Goshen Medical Center-fremont 109 S Sycamore St Fremont NC 27830-8710 Ph: (919) 242-4382 |
| NPI Number | 1679718316 |
|---|---|
| Provider Enumeration Date | 12/10/2008 |
| Last Update Date | 03/26/2010 |
| Medicare PECOS PAC ID | 3173434479 |
|---|---|
| Medicare Enrollment ID | O20100325000396 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679718316 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Jesse A Blackman, Md, Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 S. Sycamore Street, Fremont, NC 27830 Phone: 919-242-5550 Fax: 919-242-6428 |