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Organization

PEACOCK-BETTENDORF, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANNA PEACOCK BETTENDORF M.D. (MEMBER/MANAGER)
(910) 458-8616
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
2081P0004X
Spinal Cord Injury Medicine Physician
Primary
9400419
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
130AX
BLUE CROSS/BLUE SHIELD
NC
05
89130AX
NC
Enumeration date
08/24/2006
Last updated
08/22/2020
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