Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Other names
Duke Neurosurgical Associates of Lumberton
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER THOMAS FREDERICK (CFO)
(919) 613-7762
Entity
Organization
Contact information
Practice address
2936 N ELM ST, SUITE 101, LUMBERTON, NC 28358-2981
(919) 684-8111
Mailing address
PO BOX 110566, DURHAM, NC 27709-5566
(919) 620-4855
(919) 620-4921
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0228J
BCBS
NC
01
—
1029437026
TRICARE GRP
—
05
—
890228J
—
NC
Enumeration date
07/09/2006
Last updated
05/15/2022
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