Organization
PROVIDENCE MEDICAL CLINIC, INC.
Active
Organization
PROVIDENCE MEDICAL CLINIC, INC.
Active
Other names
DBA Cabarrus Mercy Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADEBOLA K. ADEKANMBI M.D. (PRESIDENT)
(704) 721-4232
Entity
Organization
Contact information
Practice address
271 NE EXECUTIVE PARK DRIVE, CONCORD, NC 28025
(704) 721-4232
(704) 721-4240
Mailing address
271 NE EXECUTIVE PARK DRIVE, CONCORD, NC 28025
(704) 721-4232
(704) 721-4240
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
9900744
NC
207R00000X
Internal Medicine Physician
Primary
NC9900744
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89012PN
—
NC
05
—
891226E
—
NC
Enumeration date
08/01/2006
Last updated
02/01/2010
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