Provider Demographics
NPI:1013174663
Name:DELCO HEALTH CLINIC
Entity Type:Organization
Organization Name:DELCO HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-442-1866
Mailing Address - Street 1:PO BOX 15009
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-5009
Mailing Address - Country:US
Mailing Address - Phone:910-442-1866
Mailing Address - Fax:
Practice Address - Street 1:25478 ANDREW JACKSON HWY E
Practice Address - Street 2:
Practice Address - City:DELCO
Practice Address - State:NC
Practice Address - Zip Code:28436-9356
Practice Address - Country:US
Practice Address - Phone:910-442-1866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890199QMedicaid