Provider Demographics
NPI:1952952574
Name:THREE PINES INTERNAL MEDICINE
Entity type:Organization
Organization Name:THREE PINES INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PESCHONG
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-207-6218
Mailing Address - Street 1:138 MEMORY PLZ
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-2640
Mailing Address - Country:US
Mailing Address - Phone:910-207-6218
Mailing Address - Fax:910-207-6219
Practice Address - Street 1:138 MEMORY PLZ
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2640
Practice Address - Country:US
Practice Address - Phone:910-207-6218
Practice Address - Fax:910-207-6219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care