Pinehurst Medical Clinic, Inc.
Legal Business Name
Pinehurst Medical Clinic, Inc.
NPI Number
1255388369
NPI Type
Organization
Enumeration Date
05/27/2006
Specialties
(Taxonomies)Name
Code
207RC0000X
207RC0001X
207RE0101X
207Q00000X
207RG0100X
207RG0300X
207RH0003X
207RI0011X
207RP1001X
Primary Taxonomy
No
No
No
No
No
No
No
No
No
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