| North Carolina Kidney Care Pc | |
|
3214 Charles B Root Wynd Ste 203 Raleigh NC 27612-5440 | |
| (720) 826-4852 | |
| Not Available |
| Full Name | North Carolina Kidney Care Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3214 Charles B Root Wynd Ste 203, Raleigh, North Carolina |
| Authorized Official Name and Position | Aaron Molitor (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 7202045760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Carolina Kidney Care Pc 1600 Stout St Ste 2000 Denver CO 80202-3113 Ph: () - | North Carolina Kidney Care Pc 3214 Charles B Root Wynd Ste 203 Raleigh NC 27612-5440 Ph: (720) 826-4852 |
| NPI Number | 1164028940 |
|---|---|
| Provider Enumeration Date | 12/08/2020 |
| Last Update Date | 03/28/2024 |
| Medicare PECOS PAC ID | 8729491097 |
|---|---|
| Medicare Enrollment ID | O20210105001361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164028940 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Kimberlyn P Bowen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861589277 PECOS PAC ID: 6901804079 Enrollment ID: I20140507000139 |
| Provider Name | Shadara M King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093286015 PECOS PAC ID: 8022355023 Enrollment ID: I20190129003346 |
| Provider Name | Farhad Modarai |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497098610 PECOS PAC ID: 8224310289 Enrollment ID: I20190424003088 |
| Provider Name | Shanita Eccles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356707855 PECOS PAC ID: 4789087800 Enrollment ID: I20210728000015 |
| Provider Name | Haley D Justus |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1861896672 PECOS PAC ID: 9638565633 Enrollment ID: I20220526001035 |
| Provider Name | Margaret Warner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093843732 PECOS PAC ID: 3779552690 Enrollment ID: I20220729001299 |
| Provider Name | Keli M Perino |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1154841328 PECOS PAC ID: 0042589749 Enrollment ID: I20220914001889 |
| Provider Name | Kaila Johnson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1821456930 PECOS PAC ID: 5294122727 Enrollment ID: I20220924000377 |
| Provider Name | Terri Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356796262 PECOS PAC ID: 6204191372 Enrollment ID: I20230810004340 |
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