Provider Demographics
NPI:1508007121
Name:CANTERWOOD MEDICAL GROUP
Entity Type:Organization
Organization Name:CANTERWOOD MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:9910-612-3252
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28402-0071
Mailing Address - Country:US
Mailing Address - Phone:910-612-3252
Mailing Address - Fax:910-254-4888
Practice Address - Street 1:2207 CANTERWOOD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7301
Practice Address - Country:US
Practice Address - Phone:910-254-4777
Practice Address - Fax:910-254-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty