Provider Demographics
NPI:1447844162
Name:NORTH RALEIGH INTEGRATED PRIMARY CARE LLP
Entity type:Organization
Organization Name:NORTH RALEIGH INTEGRATED PRIMARY CARE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRESHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-669-1982
Mailing Address - Street 1:4040 BARRETT DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6640
Mailing Address - Country:US
Mailing Address - Phone:919-689-1010
Mailing Address - Fax:
Practice Address - Street 1:4040 BARRETT DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6640
Practice Address - Country:US
Practice Address - Phone:919-689-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804626Medicaid