Provider Demographics
NPI:1376261099
Name:CCCLINIC INC
Entity Type:Organization
Organization Name:CCCLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-265-8591
Mailing Address - Street 1:141 HEALTH CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6997
Mailing Address - Country:US
Mailing Address - Phone:828-265-8591
Mailing Address - Fax:
Practice Address - Street 1:141 HEALTH CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6997
Practice Address - Country:US
Practice Address - Phone:828-265-8591
Practice Address - Fax:828-268-9963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care