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NPI 1215481460ActiveOrganization· Preferred Provider Organization· Fayetteville, NC
Preferred Provider Organization in Fayetteville, North Carolina, registered in NPPES in August 2016. The authorized official on file is Dustin Edge, Pharmacy Supervisor.
Overview
| NPI | 1215481460 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 4, 2016 |
| Last updated in NPPES | Aug 4, 2016 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Preferred Provider Organization Primary | 305R00000X | 24653 | NC |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other Preferred Provider Organization providers in Fayetteville
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All Preferred Provider Organization providers in North Carolina →