| Pleasure Island Health | |
|
1328 North Lake Park Blvd Ste 102 Carolina Beach NC 28428 | |
| (910) 399-8666 | |
| (910) 399-8664 |
| Full Name | Pleasure Island Health |
|---|---|
| Speciality | Internal Medicine |
| Location | 1328 North Lake Park Blvd Ste 102, Carolina Beach, North Carolina |
| Authorized Official Name and Position | Kenneth Christopher Farmer (OWNER) |
| Authorized Official Contact | 9103998666 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pleasure Island Health 1328 North Lake Park Blvd Ste 102 Carolina Beach NC 28428 Ph: (910) 399-8666 | Pleasure Island Health 1328 North Lake Park Blvd Ste 102 Carolina Beach NC 28428 Ph: (910) 399-8666 |
| NPI Number | 1235682022 |
|---|---|
| Provider Enumeration Date | 07/27/2016 |
| Last Update Date | 06/21/2018 |
| Medicare PECOS PAC ID | 7517255755 |
|---|---|
| Medicare Enrollment ID | O20161004001549 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235682022 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 5004456 (North Carolina) | Primary |
| 363LA2200X | Nurse Practitioner - Adult Health | 190386 (North Carolina) | Secondary |
| Provider Name | Kenneth C Farmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578793725 PECOS PAC ID: 0446306930 Enrollment ID: I20090924000698 |
| Provider Name | Donald Crawford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063052561 PECOS PAC ID: 9931537255 Enrollment ID: I20200320001275 |
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