Provider Demographics
NPI:1588811285
Name:PELICAN FAMILY MEDICINE AT MONKEY JUNCTION
Entity Type:Organization
Organization Name:PELICAN FAMILY MEDICINE AT MONKEY JUNCTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SAMUEL THOMAS
Authorized Official - Last Name:ARMITAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-332-7900
Mailing Address - Street 1:5429 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6513
Mailing Address - Country:US
Mailing Address - Phone:910-799-7078
Mailing Address - Fax:
Practice Address - Street 1:5905 CAROLINA BEACH RD STE 8
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2760
Practice Address - Country:US
Practice Address - Phone:910-792-1001
Practice Address - Fax:910-792-1004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PELICAN FAMILY MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-25
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty