Provider Demographics
NPI:1346760352
Name:MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FENECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-341-4016
Mailing Address - Street 1:1616 E MILLBROOK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4971
Mailing Address - Country:US
Mailing Address - Phone:919-341-4016
Mailing Address - Fax:910-346-1907
Practice Address - Street 1:2002 S GLENBURNIE RD STE 100
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5229
Practice Address - Country:US
Practice Address - Phone:252-631-5188
Practice Address - Fax:252-631-5189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED FIRST IMMEDIATE CARE & FAMILY PRACTICE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty