Provider Demographics
NPI:1528584588
Name:SHEPHERD'S CARE MEDICAL CLINIC
Entity Type:Organization
Organization Name:SHEPHERD'S CARE MEDICAL CLINIC
Other - Org Name:SHEPHERD'S CARE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:919-823-1618
Mailing Address - Street 1:1303 WATER PLANT RD
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-8615
Mailing Address - Country:US
Mailing Address - Phone:919-404-2474
Mailing Address - Fax:919-375-4150
Practice Address - Street 1:1303 WATER PLANT RD
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-8615
Practice Address - Country:US
Practice Address - Phone:919-404-2474
Practice Address - Fax:919-375-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty