Provider Demographics
NPI:1093785719
Name:DOWNTOWN CLINIC, P.A.
Entity Type:Organization
Organization Name:DOWNTOWN CLINIC, P.A.
Other - Org Name:THE DOWNTOWN MEDCENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:EGERER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:910-762-5588
Mailing Address - Street 1:119 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3940
Mailing Address - Country:US
Mailing Address - Phone:910-762-5588
Mailing Address - Fax:910-762-5589
Practice Address - Street 1:119 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3940
Practice Address - Country:US
Practice Address - Phone:910-762-5588
Practice Address - Fax:910-762-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69766261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012V5OtherBC/BS OF NC
NC89012V5Medicaid
NC=========OtherCOMMERCIAL INSURANCE
2308386Medicare PIN