| Medac Health Services Pa | |
|
4402 Shipyard Blvd Wilmington NC 28403 | |
| (910) 452-1400 | |
| (910) 332-1072 |
| Full Name | Medac Health Services Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 4402 Shipyard Blvd, Wilmington, North Carolina |
| Authorized Official Name and Position | Michael P. Moulton, M.d. (PRESIDENT) |
| Authorized Official Contact | 9104521400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medac Health Services Pa 4402 Shipyard Blvd Wilmington NC 28403-6161 Ph: (910) 452-1400 | Medac Health Services Pa 4402 Shipyard Blvd Wilmington NC 28403 Ph: (910) 452-1400 |
| NPI Number | 1356345920 |
|---|---|
| Provider Enumeration Date | 06/10/2005 |
| Last Update Date | 10/28/2019 |
| Medicare PECOS PAC ID | 1254220809 |
|---|---|
| Medicare Enrollment ID | O20040312000319 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356345920 | NPI | - | NPPES |
| CC2877 | Other | NC | RAILROAD MEDICARE |
| 07651 | Other | NC | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | Joseph E Williamson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1295739712 PECOS PAC ID: 3971685728 Enrollment ID: I20080131000660 |
| Provider Name | Martha L Ljung |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457356636 PECOS PAC ID: 0547283236 Enrollment ID: I20080505000607 |
| Provider Name | Robin W Herion |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841295235 PECOS PAC ID: 3476693383 Enrollment ID: I20091224000060 |
| Provider Name | Samuel B Collins |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669477055 PECOS PAC ID: 0143360099 Enrollment ID: I20091228000310 |
| Provider Name | William Treanor Hosek |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558317453 PECOS PAC ID: 9133258734 Enrollment ID: I20100519000841 |
| Provider Name | Pamela M Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558603050 PECOS PAC ID: 2163669193 Enrollment ID: I20150331000885 |
| Provider Name | Donald Paul Kohler |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215916325 PECOS PAC ID: 7012903511 Enrollment ID: I20151209002315 |
| Provider Name | Danielle S Redman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750702072 PECOS PAC ID: 4789965344 Enrollment ID: I20221026002175 |
| Provider Name | William Callard |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053505545 PECOS PAC ID: 5395872451 Enrollment ID: I20230120001643 |
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