# CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Three Rivers Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750616108
- **Authorized official:** JOSEPH B FISER (VP MANAGED CARE AND REVENUE CYCLE)
- **Authorized official phone:** (910) 615-5572

## Contact information

- **Practice address:** 580 W MCLEAN ST, SAINT PAULS, NC 28384-1421
- **Practice address phone:** (910) 615-3570
- **Practice address fax:** (910) 865-3503
- **Mailing address:** PO BOX 40908, FAYETTEVILLE, NC 28309-0908
- **Mailing address phone:** (910) 615-6448
- **Mailing address fax:** (910) 615-5070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/02/2009
- **Last updated:** 11/30/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | PENDING | — | NC |