# TAR RIVER MISSION CLINIC, INC.

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

## Provider details

- **NPI number:** 1649519612
- **Authorized official:** GENE WILSON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (252) 962-3455

## Contact information

- **Practice address:** 1041 NOELL LN, MEDICAL PLAZA B, ROCKY MOUNT, NC 27804-2058
- **Practice address phone:** (252) 962-3450
- **Practice address fax:** (252) 962-3451
- **Mailing address:** 1041 NOELL LN, MEDICAL PLAZA B, ROCKY MOUNT, NC 27804-2058
- **Mailing address phone:** (252) 962-3450
- **Mailing address fax:** (252) 962-3451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/11/2013
- **Last updated:** 02/11/2013