Provider Demographics
NPI:1356345920
Name:MEDAC HEALTH SERVICES, PA
Entity type:Organization
Organization Name:MEDAC HEALTH SERVICES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-656-2750
Mailing Address - Street 1:216 CENTERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3226
Mailing Address - Country:US
Mailing Address - Phone:910-791-0075
Mailing Address - Fax:910-791-5359
Practice Address - Street 1:4402 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-791-0075
Practice Address - Fax:910-791-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCC2877OtherRAILROAD MEDICARE
NC07651OtherBCBS
NCCC2877OtherRAILROAD MEDICARE
NC07651OtherBCBS
NC0529800002Medicare NSC
NC0529800001Medicare NSC