OPEN WATER MEDICAL, PA


Address: 109 South Vance St, Sanford, NC 27330
Phone: 9197764040

OPEN WATER MEDICAL, PA (NPI# 1760921613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1760921613
Entity Type Organization
Organization Name OPEN WATER MEDICAL, PA
Practice Address 109 South Vance St
Sanford
NC 27330
Mailing Address 1620 C Live Oak St
Beaufort
NC 28516
Practice Telephone 9197764040
Practice Fax Number 9197764043
Mailing Telephone 2527285737
Mailing Fax Number 2527285739
Enumeration Date 2017-02-13
Last Update Date 2017-02-13
Authorized Official Name KERRY A WILLIS (PRESIDENT)
Authorized Official Telephone 2527237233
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207Q00000X Family Medicine 30580 NC Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
NC 890159M 05

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1942772983 Open Water Medical, Pa Clinic/Center 4008 Nc-42, Wilson, NC 27893 2018-12-31
1437531100 Open Water Medical, Pa Family Medicine 1303 Water Plant Rd, Zebulon, NC 27597-8615 2015-06-18
1750482493 Open Water Medical, Pa Clinic/Center 1620 Live Oak St Ste C, Beaufort, NC 28516-1582 2006-09-26
1720550940 Open Water Medical, Pa Clinic/Center 1209 E Ash St, Goldsboro, NC 27530-5103 2018-12-28
1669852372 Open Water Medical, Pa Family Medicine 3106 Arendell Street, Morehead City, NC 28557-3202 2015-06-08

Office Location

Street Address 109 SOUTH VANCE ST
City SANFORD
State NC
Zip Code 27330

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1043836232 Felicia Alston Chore Provider 160a Chatham St, Sanford, NC 27330 2020-06-23
1730727470 Kathy M Taylor Homemaker 1665 Lower Moncure Rd, Sanford, NC 27330 2019-12-12
1982185377 Fhpg, LLC Internal Medicine 2925 Beechtree Dr, Suite 142, Sanford, NC 27330 2018-08-24
1154849719 Schuyler Karl Behnke Family Medicine 125 Chatham Street, Sanford, NC 27330 2017-09-05
1205375953 Dlp Central Carolina Medical Group LLC Surgery 117 Dennis Dr, Sanford, NC 27330 2017-02-14
1972050458 Brent Layne Physician Assistant 724 South Horner Blvd, Sanford, NC 27330 2016-09-01
1174977185 Jennifer Lynn Beard Physician Assistant 2412 Wilkins Drive, Sanford, NC 27330 2016-04-15
1003277252 North Carolina Wellness Community/Behavioral Health 321a Court Square, Sanford, NC 27330 2016-03-16
1518343573 The Family Doc Back To Basics Medical Practice, Pllc General Practice 1503 Elm Street, Suite C, Sanford, NC 27330 2015-07-31
1013305390 Senitra Pryor Counselor 811 North Horner Blvd, Sanford, NC 27330 2015-01-08
Find all providers in zip 27330

Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1225637333 Mcpc-8, LLC Family Medicine 3110 S Horner Blvd Ste 4&5, Sanford, NC 27332-8212 2020-10-20
1619463429 Fhpg, LLC Family Medicine 2919 Beechtree Dr, Sanford, NC 27330-6934 2018-07-04
1154849719 Schuyler Karl Behnke Family Medicine 125 Chatham Street, Sanford, NC 27330 2017-09-05
1912318247 Malathy T Sundaram M.d, LLC Family Medicine 312 Cottage St Ste A, Sanford, ME 04073-1817 2014-05-08
1487998738 Carehere LLC Family Medicine 1403 Medical Plaza Dr Ste 205, Sanford, FL 32771-1047 2012-11-26
1508120734 Jennifer Roehrs Family Medicine 2919 Beechtree Dr Ste 1120, Sanford, NC 27330-6934 2012-07-03
1871899021 Urgent Cares of America North Carolina Inc Family Medicine 724 South Horner Blvd., Sanford, NC 27330 2011-02-07
1447567698 Shri Hari Clinic, LLC Family Medicine 2200 S French Ave, Sanford, FL 32771-4253 2010-09-09
1336303346 Thang Pham Family Medicine 211 Bush Blvd, Sanford, FL 32773-6188 2008-07-18
1770780611 Robert Seitz Cline Family Medicine 801 Stuart Dr, Sanford, NC 27330-7625 2007-07-02
Find all providers in SANFORD

Competitor

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City SANFORD
Zip Code 27330

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Dataset Information

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.

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