Provider Demographics
NPI:1487874392
Name:CAPITAL PRIMARY MEDICINE AND NUTRITION CENTER
Entity type:Organization
Organization Name:CAPITAL PRIMARY MEDICINE AND NUTRITION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANITIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-570-9090
Mailing Address - Street 1:10831 FOREST PINES DR STE 110
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8077
Mailing Address - Country:US
Mailing Address - Phone:919-570-9090
Mailing Address - Fax:919-570-9043
Practice Address - Street 1:10831 FOREST PINES DR STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8077
Practice Address - Country:US
Practice Address - Phone:919-570-9090
Practice Address - Fax:919-570-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2203290BMedicare PIN
NCF90662Medicare UPIN