Provider Demographics
NPI:1093339368
Name:NC TELEHEALTH
Entity Type:Organization
Organization Name:NC TELEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C, APRN
Authorized Official - Phone:877-561-5899
Mailing Address - Street 1:PO BOX 1516
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-1516
Mailing Address - Country:US
Mailing Address - Phone:877-561-5899
Mailing Address - Fax:
Practice Address - Street 1:1030 N ROGERS LN STE 121
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6083
Practice Address - Country:US
Practice Address - Phone:877-561-5899
Practice Address - Fax:910-370-9643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty