Provider Demographics
NPI:1548740038
Name:INDYCARE MEDICAL NORTH CAROLINA
Entity Type:Organization
Organization Name:INDYCARE MEDICAL NORTH CAROLINA
Other - Org Name:INDYCARE HILLSBOROUGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-619-3269
Mailing Address - Street 1:110 BOONE SQUARE ST STE 29A
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-2665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 BOONE SQUARE ST STE 29A
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2665
Practice Address - Country:US
Practice Address - Phone:919-245-1213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty