Organization
PRIMEDOC PARK RIDGE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT REYNOLDS MD (PRESIDENT OWNER)
(843) 237-3378
Entity
Organization
Contact information
Practice address
100 HOSPITAL DR, HENDERSONVILLE, NC 28792-5272
(843) 237-3378
(843) 237-5073
Mailing address
PO BOX 60262, CHARLOTTE, NC 28260-0262
(843) 237-3378
(843) 237-5073
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
N/A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018NX
BLUE CROSS BLUE SHIELD
NC
05
—
5905717
—
NC
Enumeration date
10/17/2006
Last updated
03/16/2009
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