Basic Information
| Provider Information | |||||||||
| NPI: | 1740320076 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONSLOW DOCTORS CARE INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 WESTERN BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285466341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105771555 | ||||||||
| FaxNumber: | 9105771841 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 WESTERN BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285466341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105771555 | ||||||||
| FaxNumber: | 9105771841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 09/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | TURLINGTON | ||||||||
| AuthorizedOfficialFirstName: | WADE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9105771555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | 16475 | NC | Y | Managed Care Organizations | Exclusive Provider Organization |
ID Information
| ID | Type | State | Issuer | Description | 8913111 | 05 | NC | MEDICAID | 891074V | 05 | NC | MEDICAID | 89128JG | 05 | NC | MEDICAID |