| Kog Integrated Healthcare | |
|
810 Elm St Fayetteville NC 28303-4152 | |
| (984) 229-9005 | |
| (919) 362-0769 |
| Full Name | Kog Integrated Healthcare |
|---|---|
| Speciality | Family Medicine |
| Location | 810 Elm St, Fayetteville, North Carolina |
| Authorized Official Name and Position | David Parker (MD/OWNER) |
| Authorized Official Contact | 9842299005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kog Integrated Healthcare 810 Elm St Fayetteville NC 28303-4152 Ph: (984) 229-9005 | Kog Integrated Healthcare 810 Elm St Fayetteville NC 28303-4152 Ph: (984) 229-9005 |
| NPI Number | 1922853514 |
|---|---|
| Provider Enumeration Date | 04/18/2024 |
| Last Update Date | 02/13/2025 |
| Medicare PECOS PAC ID | 6305361304 |
|---|---|
| Medicare Enrollment ID | O20250423000399 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922853514 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | David R Parker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376547356 PECOS PAC ID: 7416920111 Enrollment ID: I20040819000213 |
| Provider Name | Amy J Henkel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457603508 PECOS PAC ID: 8426202359 Enrollment ID: I20130131000252 |
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