Provider Demographics
NPI:1770872228
Name:SCOTLAND PRIMARY CARE CLINIC INC
Entity type:Organization
Organization Name:SCOTLAND PRIMARY CARE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:MPHA
Authorized Official - Phone:910-506-4679
Mailing Address - Street 1:805 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-4724
Mailing Address - Country:US
Mailing Address - Phone:910-506-4679
Mailing Address - Fax:910-506-4699
Practice Address - Street 1:805 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4724
Practice Address - Country:US
Practice Address - Phone:910-506-4679
Practice Address - Fax:910-506-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900344363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty