RALEIGH DURHAM MEDICAL GROUP PA (NPI# 1164865416) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164865416 |
| Entity Type | Organization |
| Organization Name | RALEIGH DURHAM MEDICAL GROUP PA |
| Other Organization Name | FAMILY WELLNESS CLINIC |
| Practice Address |
2076 Highway 42 West Suite 230 Clayton NC 27520 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 9195535711 |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2013-04-16 |
| Authorized Official Name | KENNY HEINE (VP OF OPERATIONS) |
| Authorized Official Telephone | 8589641506 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | 200400430 | NC | Suppliers |
| Other Name | Type Code |
|---|---|
| Family Wellness Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891704789 | Raleigh Durham Medical Group Pa | Family Medicine | 101 East Corbin St, Hillsborough, NC 27278 | 2006-08-07 |
| 1356387245 | Raleigh Durham Medical Group Pa | Obstetrics & Gynecology | 7019 Harps Mill Rd, Raleigh, NC 27615-3248 | 2006-06-21 |
| 1306899125 | Raleigh Durham Medical Group Pa | Family Medicine | 7124 Knightdale Blvd, Knightdale, NC 27545-9265 | 2006-05-19 |
| 1801848049 | Raleigh Durham Medical Group Pa | Family Medicine | 4905 Green Rd, Ste 100, Raleigh, NC 27616-2805 | 2006-05-16 |
| 1003868258 | Raleigh Durham Medical Group Pa | Family Medicine | 600 New Waverly Place, Ste 203, Cary, NC 27518 | 2006-05-16 |
| 1659322436 | Raleigh Durham Medical Group Pa | Family Medicine | 2076 Highway 42 W, Suite 230, Clayton, NC 27520-5303 | 2006-05-15 |
| 1649221342 | Raleigh Durham Medical Group Pa | Internal Medicine | 4003 N Roxboro St, Durham, NC 27704-2119 | 2006-05-15 |
| 1295784874 | Raleigh Durham Medical Group Pa | Obstetrics & Gynecology | 5420 Wade Park Blvd, Suite 106, Raleigh, NC 27607-4189 | 2006-05-09 |
| 1710331640 | Raleigh Durham Medical Group Pa | Non-Pharmacy Dispensing Site | 8020 Creedmoor Rd, Raleigh, NC 27613-4363 | 2016-04-18 |
| 1912243189 | Raleigh Durham Medical Group Pa | Non-Pharmacy Dispensing Site | 107 Weeks Dr, Roxboro, NC 27573-3933 | 2012-12-17 |
| Street Address |
2076 HIGHWAY 42 WEST SUITE 230 |
| City | CLAYTON |
| State | NC |
| Zip Code | 27520 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891094470 | Elizabeth Ruth Bagsby | Physical Medicine & Rehabilitation | 2076 Highway 42 West, Ste 300, Clayton, NC 27520 | 2011-03-22 |
| 1104289693 | Emergeortho, Pa | Durable Medical Equipment & Medical Supplies | 2076 Highway 42 West, Clayton, NC 27520-5302 | 2016-04-01 |
| 1689031775 | William H Jones | Physical Therapy Assistant | 2076 Highway 42 West, Clayton, NC 27520 | 2016-01-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336750959 | Ebony Nichole Sanders | Driver | 312 Kilgo, Clayton, NC 27520 | 2020-08-17 |
| 1831701382 | Deawna Jackson | Social Worker | 205 Gracie Lane, Clayton, NC 27520 | 2020-08-17 |
| 1952947798 | Mac Partners LLC | Home Health | 10027 Hwy 70 Business, Suite B, Clayton, NC 27520 | 2019-11-26 |
| 1386291102 | Benjamin R Anderson | Physician Assistant | 2138 Nc 42, Clayton, NC 27520 | 2019-08-26 |
| 1396217923 | Lindsey R. Williams Dds, Pa | Dentist | 45 Shotwell Rd., Clayton, NC 27520 | 2018-12-20 |
| 1063987303 | Christopher James Lane | Physician Assistant | 2076 Nc 42 W, Suite 230, Clayton, NC 27520 | 2018-10-12 |
| 1245733971 | Cordelia O Emebo | Pharmacist | 11360 Old Us Hwy 70 West, Clayton, NC 27520 | 2018-03-08 |
| 1487166906 | Kendall Bonot Rodgers | Physician Assistant | 11491 Us 70 Bus Hwy W, Clayton, NC 27520 | 2017-10-25 |
| 1033620828 | Laura Nguyen | Physician Assistant | 2076 Nc-42, Suite 230, Clayton, NC 27520 | 2017-10-19 |
| 1467974394 | Liliana Galvan | Social Worker | 510 W Main St., Suit 100, Clayton, NC 27520 | 2017-07-12 |
| Find all providers in zip 27520 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720120819 | Clayton Valley Medical Group, Inc. | Non-Pharmacy Dispensing Site | 1520 Kirker Pass Rd, Suite A, Clayton, CA 94517-1096 | 2007-02-13 |
| 1710222708 | Urgent Cares of America North Carolina Inc | Non-Pharmacy Dispensing Site | 11491 Us Highway 70 W, Clayton, NC 27520 | 2012-12-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952775108 | Urgent Cares of America North Carolina Inc | Non-Pharmacy Dispensing Site | 907 Us 401 Bypass, Laurinburg Commons, Laurinburg, NC 28352 | 2015-11-25 |
| 1417321381 | Urgent Cares of America Nc Inc | Non-Pharmacy Dispensing Site | 5214 Market St, Wilmington, NC 28405-4067 | 2015-11-16 |
| 1003280033 | Urgent Cares of America North Carolina Inc | Non-Pharmacy Dispensing Site | 825 Blowing Rock Blvd, Lenoir, NC 28645-3709 | 2015-11-13 |
| 1659741361 | Urgent Cares of America North Carolina Inc | Non-Pharmacy Dispensing Site | 1262 East Broad Avenue, Rockingham, NC 28379 | 2015-10-07 |
| 1740650456 | Urgent Cares of America North Carolina Inc | Non-Pharmacy Dispensing Site | 220 Us Highway 70 West, Garner, NC 27529 | 2015-10-07 |
| 1033589072 | Urgent Cares of America North Carolina Inc | Non-Pharmacy Dispensing Site | 6010 Glenwood Ave, Raleigh, NC 27612-2602 | 2015-10-02 |
| 1922478205 | Urgent Cares of America North Carolina Inc | Non-Pharmacy Dispensing Site | 910 N Madison Blvd, Suite B, Roxboro, NC 27573-4573 | 2015-09-30 |
| 1942679519 | Urgent Cares of America North Carolina Inc | Non-Pharmacy Dispensing Site | 511 Smoky Park Hwy, Candler, NC 28715-8613 | 2015-09-24 |
| 1164891016 | Urgent Cares of America North Carolina Inc | Non-Pharmacy Dispensing Site | 212 N Spence Ave, Goldsboro, NC 27534-4318 | 2015-09-22 |
| 1811363674 | Unc Physicians Network, LLC | Non-Pharmacy Dispensing Site | 7100-9 Kit Creek Road, Research Triangle Park, NC 27709 | 2015-08-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.