Provider Demographics
NPI:1851577167
Name:CLARKTON HEALTH CENTER PA
Entity Type:Organization
Organization Name:CLARKTON HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SILVERIO
Authorized Official - Middle Name:CASTRO
Authorized Official - Last Name:ENOJADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-647-4311
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-0308
Mailing Address - Country:US
Mailing Address - Phone:910-647-4311
Mailing Address - Fax:910-647-0123
Practice Address - Street 1:203 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-0308
Practice Address - Country:US
Practice Address - Phone:910-647-4311
Practice Address - Fax:910-647-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20266208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930679Medicaid
NCD62845Medicare UPIN