Provider Demographics
NPI:1629101746
Name:ROCKFISH MEDICAL CLINIC, PLLC
Entity Type:Organization
Organization Name:ROCKFISH MEDICAL CLINIC, PLLC
Other - Org Name:THE JORDAN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PA-C OFFICE MGR.
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-875-9087
Mailing Address - Street 1:116 CAMPUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 CAMPUS AVENUE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376
Practice Address - Country:US
Practice Address - Phone:910-875-9087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty