Provider Demographics
NPI:1912190406
Name:CYNTHIA WELLS MCLEMORE
Entity Type:Organization
Organization Name:CYNTHIA WELLS MCLEMORE
Other - Org Name:COMPANY HEALTH MOORE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-995-7941
Mailing Address - Street 1:PO BOX 4534
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-4534
Mailing Address - Country:US
Mailing Address - Phone:910-995-7941
Mailing Address - Fax:866-206-0778
Practice Address - Street 1:61 MCKOY STREET
Practice Address - Street 2:
Practice Address - City:HOFFMAN
Practice Address - State:NC
Practice Address - Zip Code:28347-9735
Practice Address - Country:US
Practice Address - Phone:910-995-7941
Practice Address - Fax:866-206-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26678302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909200Medicaid
NC8950341Medicaid
NC2281162AMedicare PIN
NCC86736Medicare UPIN
NC2281162BMedicare PIN