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HOMETOWN MED OF MOYOCK AND OBX PLLC NPI 1750021325


NPI Information

NPI: 1750021325
Provider Name: HOMETOWN MED OF MOYOCK AND OBX PLLC

Doing Business As: HOMETOWN MED OF MOYOCK AND OBX PLLC

Classification: Nurse Practitioner - 363LP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 34D2263381

Address:
109 CURRITUCK COMMERICAL DR STE A
MOYOCK, NC
ZIP 27958
Phone: (252) 772-1110
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HOMETOWN MED OF MOYOCK AND OBX PLLC is a primary care nurse practitioner in Moyock, NC. HOMETOWN MED OF MOYOCK AND OBX PLLC NPI is 1750021325. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Hometown Med Of Moyock And Obx Pllc.

The provider's business location address is:

109 CURRITUCK COMMERICAL DR STE A
MOYOCK, NC
ZIP 27958-068
Phone: (252) 772-1110
Fax: (252) 319-3678

The provider's authorized official is Carmen M Wynes .
The authorized official title is Owner and has the following contact phone number (252) 772-1110.

The CLIA number assigned to this NPI record is 34D2263381 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/31/2022 and was last updated on 4/26/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineNo
22083A0300XPreventive MedicineAddiction MedicineNo
3261QP2300XClinic/CenterPrimary CareNo
4363LP2300XNurse PractitionerPrimary CareYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11073000816MEDICAIDVIRGINIA
21750021325MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.