| Holly Ridge Healthcare Pa | |
|
119 Holly St Holly Ridge NC 28445-7898 | |
| (910) 329-1707 | |
| (910) 329-1716 |
| Full Name | Holly Ridge Healthcare Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 119 Holly St, Holly Ridge, North Carolina |
| Authorized Official Name and Position | James Henry Pridgen (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9103291707 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holly Ridge Healthcare Pa 119 Holly St Holly Ridge NC 28445-7898 Ph: (910) 329-1707 | Holly Ridge Healthcare Pa 119 Holly St Holly Ridge NC 28445-7898 Ph: (910) 329-1707 |
| NPI Number | 1558544957 |
|---|---|
| Provider Enumeration Date | 12/10/2007 |
| Last Update Date | 03/28/2019 |
| Medicare PECOS PAC ID | 0840370276 |
|---|---|
| Medicare Enrollment ID | O20080110000278 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558544957 | NPI | - | NPPES |
| 89012R8 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 29495 (North Carolina) | Primary |
| Provider Name | James H Pridgen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215083563 PECOS PAC ID: 9032014154 Enrollment ID: I20041006000438 |
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Holly Ridge Healthcare Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 308 Hwy 17 N, Holly Ridge, NC 28445 Phone: 910-329-1707 Fax: 910-251-7777 | |
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