Provider Demographics
NPI:1811917412
Name:FOUR COUNTY PRIMARY CARE, RLLP
Entity type:Organization
Organization Name:FOUR COUNTY PRIMARY CARE, RLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHATMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:252-436-1101
Mailing Address - Street 1:120 CHARLES ROLLINS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2882
Mailing Address - Country:US
Mailing Address - Phone:252-436-0440
Mailing Address - Fax:
Practice Address - Street 1:120 CHARLES ROLLINS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2882
Practice Address - Country:US
Practice Address - Phone:252-436-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890214QMedicaid
NC2329709Medicare PIN