Provider Demographics
NPI:1356695613
Name:NORTH RIVER PRIMECARE PC
Entity type:Organization
Organization Name:NORTH RIVER PRIMECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:RANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-728-3252
Mailing Address - Street 1:301 JONES AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-1514
Mailing Address - Country:US
Mailing Address - Phone:252-728-3252
Mailing Address - Fax:252-728-3251
Practice Address - Street 1:301 JONES AVE
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-1514
Practice Address - Country:US
Practice Address - Phone:252-728-3252
Practice Address - Fax:252-728-3251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900119363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907341Medicaid
NC7004406Medicaid
NC7005549Medicaid
NC7005549Medicaid