Provider Demographics
NPI:1174806202
Name:NP PRIMARY CARE HOUSE CALLS
Entity type:Organization
Organization Name:NP PRIMARY CARE HOUSE CALLS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAVIS
Authorized Official - Middle Name:OSEI
Authorized Official - Last Name:YEBOAH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:336-549-6221
Mailing Address - Street 1:5405 CARRIAGE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-9249
Mailing Address - Country:US
Mailing Address - Phone:336-549-6221
Mailing Address - Fax:
Practice Address - Street 1:5405 CARRIAGE WOODS DR
Practice Address - Street 2:
Practice Address - City:BROWNS SUMMIT
Practice Address - State:NC
Practice Address - Zip Code:27214-9249
Practice Address - Country:US
Practice Address - Phone:336-549-6221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC191252302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003059478Medicaid
NC7004358Medicaid
NC7004358Medicaid