Basic Information
| Provider Information | |||||||||
| NPI: | 1487178588 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1616 E MILLBROOK RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276094971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193414016 | ||||||||
| FaxNumber: | 9103461907 | ||||||||
| Practice Location | |||||||||
| Address1: | 2115 S MAIN ST STE A | ||||||||
| Address2: | |||||||||
| City: | WAKE FOREST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275875011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195702000 | ||||||||
| FaxNumber: | 9195702001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2017 | ||||||||
| LastUpdateDate: | 01/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | FENECK | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9193414016 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 01/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.