Provider Demographics
NPI:1790796118
Name:HEALTH PLUS OF NC PA
Entity Type:Organization
Organization Name:HEALTH PLUS OF NC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:910-974-7555
Mailing Address - Street 1:210 EAST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:CANDOR
Mailing Address - State:NC
Mailing Address - Zip Code:27229-8088
Mailing Address - Country:US
Mailing Address - Phone:910-974-7555
Mailing Address - Fax:910-974-4555
Practice Address - Street 1:210 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:CANDOR
Practice Address - State:NC
Practice Address - Zip Code:27229-8088
Practice Address - Country:US
Practice Address - Phone:910-974-7555
Practice Address - Fax:910-974-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
NC9701632208D00000X
NC101376363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCO11WUOtherBCBS
NC89011WUMedicaid
NC2344648OtherMEDICARE