Basic Information
| Provider Information | |||||||||
| NPI: | 1831799667 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAKERSVILLE COMMUNITY MEDICAL CLINIC, INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 SEVEN MILE RIDGE RD | ||||||||
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| City: | BURNSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287148509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286828102 | ||||||||
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| Practice Location | |||||||||
| Address1: | 71 BLUE RIDGE LN | ||||||||
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| City: | BURNSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287147270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286758102 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2020 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROBINSON | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8286750796 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAKERSVILLE COMMUNITY MEDICAL CLINIC, INCORPORATED | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
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.