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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