Provider Demographics
NPI:1457647885
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:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-346-2273
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28541-0686
Mailing Address - Country:US
Mailing Address - Phone:910-346-2273
Mailing Address - Fax:910-346-1907
Practice Address - Street 1:7901 EMERALD DRIVE
Practice Address - Street 2:STE 7
Practice Address - City:EMERALD ISLE
Practice Address - State:NC
Practice Address - Zip Code:28549-2880
Practice Address - Country:US
Practice Address - Phone:252-354-6500
Practice Address - Fax:252-354-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty