Provider Demographics
NPI:1548565153
Name:MONTGOMERY COUNTY PRIMARY CARE CORP
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY PRIMARY CARE CORP
Other - Org Name:FIRSTHEALTH FAMILY CARE CENTER - JORDAN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:G
Authorized Official - Last Name:VOELPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-715-2261
Mailing Address - Street 1:PO BOX 843145
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3145
Mailing Address - Country:US
Mailing Address - Phone:866-265-7922
Mailing Address - Fax:617-402-1099
Practice Address - Street 1:116 CAMPUS AVENUE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2606
Practice Address - Country:US
Practice Address - Phone:910-875-9087
Practice Address - Fax:910-875-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty