Organization
WINTERGREEN MEDICAL CENTER, PLLC
Active
Parent organization
WINTERGREEN MEDICAL CENTER, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WINTERGREEN MEDICAL CENTER, PLLC
Authorized official
LELAND CALVIN ELLIS PA-C (OWNER)
(252) 551-5595
Entity
Organization
Contact information
Practice address
324A BEACON DR, WINTERVILLE, NC 28590-7956
(252) 551-5595
(252) 321-7762
Mailing address
324-A BEACON DR, WINTERVILLE, NC 28590-7956
(252) 551-5595
(252) 321-7762
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
141455
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8976432
—
NC
Enumeration date
07/20/2007
Last updated
02/18/2016
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