Provider Demographics
NPI:1043507130
Name:ACME MEDICAL SPECIALTIES, PLLC
Entity Type:Organization
Organization Name:ACME MEDICAL SPECIALTIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:AGYEI-GYAMFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-739-5197
Mailing Address - Street 1:2914 N ELM ST
Mailing Address - Street 2:PMB # 130
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2981
Mailing Address - Country:US
Mailing Address - Phone:910-739-5197
Mailing Address - Fax:910-739-5294
Practice Address - Street 1:4348 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2677
Practice Address - Country:US
Practice Address - Phone:910-739-5197
Practice Address - Fax:910-739-5294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00720207RG0100X
NC2011-01204207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918983Medicaid
NCA419Medicare PIN