Provider Demographics
NPI:1407045628
Name:THE YROGERG MEDICAL GROUP, P.L.L.C
Entity Type:Organization
Organization Name:THE YROGERG MEDICAL GROUP, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT / ADMINISTRATIV
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:910-522-7185
Mailing Address - Street 1:201 E. LIVERMORE DRIVE SUITE #1
Mailing Address - Street 2:ANGEL EXCHANGE
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372
Mailing Address - Country:US
Mailing Address - Phone:910-522-7185
Mailing Address - Fax:910-522-7184
Practice Address - Street 1:201 E. LIVERMORE DRIVE SUITE #1
Practice Address - Street 2:ANGEL EXCHANGE
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372
Practice Address - Country:US
Practice Address - Phone:910-522-7185
Practice Address - Fax:910-522-7184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC145009363A00000X, 363AM0700X
NC103971363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty