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Contact Information

INDEPENDENCE MEDICAL, PA
515 BARBOUR RD
SMITHFIELD, NC27577-7698
 Phone: 919-544-4747
 Fax: 919-544-0104
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for INDEPENDENCE MEDICAL, PA

NPI # 1700845112
LBN Legal business name INDEPENDENCE MEDICAL, PA
Authorized official BERNARD BENNETT - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 03/23/2006
Last updated 10/31/2013 - About 13 years ago
Identifiers
NC License # 36493
NC Medicaid 1028P
NC Medicaid 891028P
NC Other DA5493 MEDICARE RAILROAD
NC Other P00062870 MEDICARE RAILROAD
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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