Basic Information
| Provider Information | |||||||||
| NPI: | 1487934006 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTGOMERY COUNTY FREE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 296 | ||||||||
| Address2: | 104 PROFESSIONAL DRIVE | ||||||||
| City: | BISCOE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104289020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 104 PROFESSIONAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | BISCOE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104289020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2011 | ||||||||
| LastUpdateDate: | 08/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | WATSON | ||||||||
| AuthorizedOfficialFirstName: | BENITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9104289020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | 5005256 | NC | Y | Agencies | Public Health or Welfare |
No ID Information.