# PEACOCK-BETTENDORF, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134236078
- **Authorized official:** ANNA PEACOCK BETTENDORF M.D. (MEMBER/MANAGER)
- **Authorized official phone:** (910) 458-8616

## Contact information

- **Practice address:** 2208 S 17TH ST, SECOND FLOOR, WILMINGTON, NC 28401-7515
- **Practice address phone:** (910) 251-6755
- **Practice address fax:** (910) 458-8619
- **Mailing address:** PO BOX 15671, WILMINGTON, NC 28408-5671
- **Mailing address phone:** (910) 251-6755
- **Mailing address fax:** (910) 458-8619

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P0004X | Spinal Cord Injury Medicine Physician | 9400419 | NC | Yes |

## Other

- **Enumeration date:** 08/24/2006
- **Last updated:** 08/22/2020