Organization

Pinehurst Medical Clinic, Inc.

Legal Business Name

Pinehurst Medical Clinic, Inc.

NPI Number

1255388369

NPI Type

Organization

Enumeration Date

05/27/2006

Licenses

State

North Carolina

License Number

39578

Contact
Information

Purpose

Mailing
Location

Address

200 PAVILION WAY
205 PAGE RD

City

Southern Pines
Pinehurst

State

NC
NC

Postal Code

28387-4561
28374-8798

Country

US
US

Telephone Number

(910) 295-5511
(910) 295-5511

Authorized Official

Name

Mr. Brandon Enfinger

Title or Position

CEO

Telephone Number

(910) 235-3004

Identifiers

Identifier

CC6114
NPA775
0395360001
8902418
02418

Identifier State

NC
SC
NC
NC
NC

Identifier Issuer

PALMETTO GBA GROUP#
SC MEDICAID GROUP#
DME-PALMETTO GROUP#
Unknown
BC/BS NC GROUP #

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 02/16/2023

Provider Address