| Opportunities Industrialization Center, Inc | |
|
2309 Sunset Ave Rocky Mount NC 27804-2529 | |
| (252) 210-9856 | |
| Not Available |
| Full Name | Opportunities Industrialization Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2309 Sunset Ave, Rocky Mount, North Carolina |
| Authorized Official Name and Position | Shirley Monk-jones (BILLING MANAGER) |
| Authorized Official Contact | 2522123486 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Opportunities Industrialization Center, Inc Po Box 2723 Rocky Mount NC 27802-2723 Ph: (252) 212-6802 | Opportunities Industrialization Center, Inc 2309 Sunset Ave Rocky Mount NC 27804-2529 Ph: (252) 210-9856 |
| NPI Number | 1578219424 |
|---|---|
| Provider Enumeration Date | 03/01/2022 |
| Last Update Date | 03/01/2022 |
| Medicare PECOS PAC ID | 3173563590 |
|---|---|
| Medicare Enrollment ID | O20221009000067 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578219424 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Tisa O Roberts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942342159 PECOS PAC ID: 7719088624 Enrollment ID: I20070723000339 |
| Provider Name | Tonya Denise Hasty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346965324 PECOS PAC ID: 1759759087 Enrollment ID: I20221117002225 |
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