Organization
BLADEN HEALTHCARE LLC
Active
Parent organization
BLADEN HEALTHCARE LLC
Other names
Phillips Internal Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLADEN HEALTHCARE LLC
Authorized official
MR. AYUB IBRAHIM JR. (REIMBURSEMENT DIRECTOR)
(910) 615-6994
Entity
Organization
Contact information
Practice address
507 DOCTOR'S DRIVE, ELIZABETHTOWN, NC 28337
(910) 862-3212
(910) 862-2263
Mailing address
PO BOX 398, ELIZABETHTOWN, NC 28337-0398
(910) 862-3212
(910) 862-2263
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15560
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8967555
—
NC
Enumeration date
08/20/2006
Last updated
01/13/2010
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