Basic Information
| Provider Information | |||||||||
| NPI: | 1619517976 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAKERSVILLE COMMUNITY MEDICAL CLINIC, INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 N MITCHELL AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287056502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286882104 | ||||||||
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| Practice Location | |||||||||
| Address1: | 89 N MITCHELL AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287056502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286882104 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2020 | ||||||||
| LastUpdateDate: | 01/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROBINSON | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8286828102 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAKERSVILLE COMMUNITY MEDICAL CLINIC, INCORPORATED | ||||||||
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| NPICertificationDate: | 01/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.