Provider Demographics
NPI:1932297751
Name:LAUREL HILL MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:LAUREL HILL MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-462-2707
Mailing Address - Street 1:18901 IDA MILL RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28351-8326
Mailing Address - Country:US
Mailing Address - Phone:910-462-2707
Mailing Address - Fax:910-462-4184
Practice Address - Street 1:18901 IDA MILL RD
Practice Address - Street 2:
Practice Address - City:LAUREL HILL
Practice Address - State:NC
Practice Address - Zip Code:28351-8326
Practice Address - Country:US
Practice Address - Phone:910-462-2707
Practice Address - Fax:910-462-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343964AMedicaid
NC343964AMedicaid