Provider Demographics
NPI:1831772748
Name:PHYSICIAN MANAGEMENT SERVICES OF NORTH CAROLINA, LLC
Entity type:Organization
Organization Name:PHYSICIAN MANAGEMENT SERVICES OF NORTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:KENEFICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-829-8550
Mailing Address - Street 1:3113 LAWTON RD STE 250
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7490 ANDREW JACKSON HWY SW
Practice Address - Street 2:
Practice Address - City:CERRO GORDO
Practice Address - State:NC
Practice Address - Zip Code:28430-9258
Practice Address - Country:US
Practice Address - Phone:888-829-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAXCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty