Organization
M8D2RISE EAGLES PROGRAM, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIFANIE L. RUDD (OWNER)
(336) 907-7268
Entity
Organization
Contact information
Practice address
2302 W MEADOWVIEW RD, SUITE 124 MOREHEAD BLDG., GREENSBORO, NC 27407-3721
(336) 907-7268
(336) 707-7311
Mailing address
2302 W MEADOWVIEW RD, SUITE 124 MOREHEAD BLDG., GREENSBORO, NC 27407-3721
(336) 907-7268
(336) 707-7311
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
281050
NC
Other
Enumeration date
02/27/2013
Last updated
02/27/2013
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