Provider Demographics
NPI:1285658021
Name:PEMBROKE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:PEMBROKE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:WORIAX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-521-0510
Mailing Address - Street 1:PO BOX 3609
Mailing Address - Street 2:102 SOUTH MAIN STREET
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-3609
Mailing Address - Country:US
Mailing Address - Phone:910-521-0510
Mailing Address - Fax:910-521-5582
Practice Address - Street 1:102 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372
Practice Address - Country:US
Practice Address - Phone:910-521-0510
Practice Address - Fax:910-521-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890135AMedicaid
C81009Medicare UPIN
NC201998AMedicare ID - Type Unspecified