Provider Demographics
NPI:1497975411
Name:MAURICE K. KPEGLO
Entity Type:Organization
Organization Name:MAURICE K. KPEGLO
Other - Org Name:FIRST AID EMERGENCY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:KOBLA
Authorized Official - Last Name:KPEGLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-378-0760
Mailing Address - Street 1:PO BOX 14914
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4914
Mailing Address - Country:US
Mailing Address - Phone:336-378-0760
Mailing Address - Fax:336-378-0970
Practice Address - Street 1:2025 MARTIN L. KING JR DR.
Practice Address - Street 2:SUITE-E
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-3334
Practice Address - Country:US
Practice Address - Phone:336-378-0760
Practice Address - Fax:336-378-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001360016208D00000X
NC29314208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950296Medicaid
NCC87540Medicare UPIN
NC212388-GMedicare PIN