Provider Demographics
NPI:1245426618
Name:ROCKWELL MEDICAL CLINIC
Entity Type:Organization
Organization Name:ROCKWELL MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:704-279-7227
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-1060
Mailing Address - Country:US
Mailing Address - Phone:704-279-7227
Mailing Address - Fax:
Practice Address - Street 1:307 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138-6761
Practice Address - Country:US
Practice Address - Phone:704-279-7227
Practice Address - Fax:704-279-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-01366173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-64116Medicaid
NC126546667OtherNPI
NCG14208Medicare UPIN
NC2318992Medicare PIN