Organization
INDEPENDENCE MEDICAL, PA
Active
Organization
INDEPENDENCE MEDICAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNARD L BENNETT M.D. (PRESIDENT)
(919) 622-8272
Entity
Organization
Contact information
Practice address
515 BARBOUR RD, SMITHFIELD, NC 27577-7698
(919) 544-4747
(919) 544-0104
Mailing address
1209 FALLS BRIDGE DR, RALEIGH, NC 27614-8935
(919) 544-4747
(919) 544-0104
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
36493
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028P
—
NC
05
—
891028P
—
NC
01
—
DA5493
MEDICARE RAILROAD
NC
01
—
P00062870
MEDICARE RAILROAD
NC
Enumeration date
03/23/2006
Last updated
10/31/2013
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