# MIDWAY MEDICAL CENTER, PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MIDWAY MEDICAL CENTER, PA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1699921999
- **Legal business name:** MIDWAY MEDICAL CENTER, PA
- **Authorized official:** MARK E KINTER MD (PRESIDENT)
- **Authorized official phone:** (828) 627-2211

## Contact information

- **Practice address:** 6750 CAROLINA BLVD, CLYDE, NC 28721-7052
- **Practice address phone:** (828) 627-2211
- **Practice address fax:** (855) 876-9354
- **Mailing address:** 6750 CAROLINA BLVD, CLYDE, NC 28721-7052
- **Mailing address phone:** (828) 627-2211
- **Mailing address fax:** (855) 876-9354

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 62447 | NC | Yes |

## Other

- **Enumeration date:** 08/18/2008
- **Last updated:** 08/01/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4245150001 | MEDICARE DME | NC |
| 05 | — | 5900304 | — | NC |
| 01 | — | C17128 | RR MEDICARE | NC |