Basic Information
| Provider Information | |||||||||
| NPI: | 1528478237 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPPORTUNITIES INDUSTRIALIZATION CENTER, INC | ||||||||
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| OtherOrganizationName: | OIC FAMILY MEDICAL CENTER AT HAPPY HILL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2723 | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278022723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522109856 | ||||||||
| FaxNumber: | 2522123497 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 N GRACE ST | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278045345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522109856 | ||||||||
| FaxNumber: | 2522123497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2014 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | BLACKWELL | ||||||||
| AuthorizedOfficialFirstName: | REUBEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2522123480 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OPPORTUNITIES INDUSTRIALIZATION CENTER, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.