| Longevity Accountable Care, PA | |
|
635 Statesville Blvd Salisbury NC 28144-2201 | |
| (704) 633-7390 | |
| Not Available |
| Full Name | Longevity Accountable Care, PA |
|---|---|
| Speciality | Family Medicine |
| Location | 635 Statesville Blvd, Salisbury, North Carolina |
| Authorized Official Name and Position | Diane Vincur (PRACTICE MANAGER) |
| Authorized Official Contact | 5618152427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Accountable Care, PA 11780 Us Highway 1 Ste N107 Palm Beach Gardens FL 33408-3007 Ph: (561) 815-2427 | Longevity Accountable Care, PA 635 Statesville Blvd Salisbury NC 28144-2201 Ph: (704) 633-7390 |
| NPI Number | 1396584454 |
|---|---|
| Provider Enumeration Date | 05/20/2024 |
| Last Update Date | 05/20/2024 |
| Certification Date | 05/20/2024 |
| Medicare PECOS PAC ID | 0840734034 |
|---|---|
| Medicare Enrollment ID | O20240718000268 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396584454 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | () | Primary |
| 363LG0600X | Nurse Practitioner - Gerontology | () | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | () | Secondary |
| Provider Name | Eileen M Quilty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891773008 PECOS PAC ID: 6709892250 Enrollment ID: I20060221000882 |
| Provider Name | Kim K Neely |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1912084013 PECOS PAC ID: 4385652643 Enrollment ID: I20060328000417 |
| Provider Name | Ann Hyatt Poplin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740327337 PECOS PAC ID: 1355402660 Enrollment ID: I20081204000963 |
| Provider Name | Sherry L Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952675209 PECOS PAC ID: 4587811633 Enrollment ID: I20140502001869 |
| Provider Name | Lashonda H Barnette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639596851 PECOS PAC ID: 0648493106 Enrollment ID: I20140602001251 |
| Provider Name | Solace E Ninyeh Assimeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891137311 PECOS PAC ID: 2466676499 Enrollment ID: I20140613001597 |
| Provider Name | Kristie Richmond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467854828 PECOS PAC ID: 9931321437 Enrollment ID: I20171019000538 |
| Provider Name | Jessica Hope Schwartz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417468042 PECOS PAC ID: 1658638218 Enrollment ID: I20171206002995 |
| Provider Name | Wayne Edward Lawing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558994699 PECOS PAC ID: 8820414717 Enrollment ID: I20210812003849 |
| Provider Name | Lauren Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265050181 PECOS PAC ID: 7315342441 Enrollment ID: I20210826003226 |
| Provider Name | Whitney Moody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730858226 PECOS PAC ID: 0143627620 Enrollment ID: I20210927001017 |
| Provider Name | Pamela Mccarthy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265192702 PECOS PAC ID: 5890187892 Enrollment ID: I20220125002949 |
| Provider Name | Nicole Calhoun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306481114 PECOS PAC ID: 7719377159 Enrollment ID: I20220413001871 |
| Provider Name | James Kinser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043629611 PECOS PAC ID: 7315167467 Enrollment ID: I20220613001735 |
| Provider Name | Sophia Gavgani Mclaughlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780334268 PECOS PAC ID: 4082095815 Enrollment ID: I20220725002712 |
| Provider Name | Whitney Michelle Poole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518509801 PECOS PAC ID: 3577996511 Enrollment ID: I20221014002047 |
| Provider Name | Jackie Wiszczur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689062390 PECOS PAC ID: 4284954975 Enrollment ID: I20240813002212 |
| Provider Name | Linda B Charron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336532498 PECOS PAC ID: 8325359441 Enrollment ID: I20260217002797 |
| Provider Name | Travis Droz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487510327 PECOS PAC ID: 4981186897 Enrollment ID: I20260228000301 |
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