Organization
PEDS FOCUS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOAN WERKAU PTA (OFFICE MANAGER)
(252) 266-4678
Entity
Organization
Contact information
Practice address
2451 HURT DR, ROCKY MOUNT, NC 27804-7976
(252) 266-4678
Mailing address
2451 HURT DR, ROCKY MOUNT, NC 27804-7976
(252) 266-4678
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1935
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0777Y
BCBS GROUP NUMBER
NC
05
—
7211016
—
NC
Enumeration date
03/12/2007
Last updated
07/25/2008
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