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MT. OLIVE FAMILY MEDICINE CENTER
NPI 1639491038
Non-Pharmacy Dispensing Site in Mount Olive, NC

Active since February 26, 2010CLIA 34D0695267 · Waiver
201 N BREAZEALE AVE, MOUNT OLIVE, NC 28365(919) 658-4954 Get Directions Write a Review

NPPES record last updated: October 23, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mt. Olive Family Medicine Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MT. OLIVE FAMILY MEDICINE CENTER (NPI 1639491038) is a healthcare organization registered as a non-pharmacy dispensing site in Mount Olive, North Carolina and active in the NPI registry since February 2010. The organization holds a CLIA Waiver certificate valid through October 31, 2026 and lists Kenny Heine, Sr. Director Of Operations, as its authorized official.

NPPES Registry Identity

NPI1639491038
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameMT. OLIVE FAMILY MEDICINE CENTER
Location Address201 N BREAZEALE AVEMount Olive, NC 28365-1603
Mailing Address5626 Oberlin Dr, Suite 110San Diego, CA 92121-1705
Phone(919) 658-4954
Organization SubpartYesParent: Medvantx, Inc.
Authorized OfficialKenny HeineSr. Director Of Operations · (858) 625-2990
Enumeration DateFebruary 26, 2010
Last NPPES UpdateOctober 23, 2012
✔ NPI 1639491038 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
License✔ Licensed in NC · 9801525
Definition

A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

201 N BREAZEALE AVE, Mount Olive, NC 28365
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D0695267

Mount Olive Family Medicine Center, Inc · Mount Olive, NC
Active · expires Oct 31, 2026
CLIA Number34D0695267
Laboratory TypePhysician Office
Certificate Effective DateNovember 1, 2024
Certificate Expiration DateOctober 31, 2026
Laboratory DirectorMr. Thomas Scott Draughon
Laboratory Phone(919) 658-4954
Laboratory LocationMount Olive Family Medicine Center, Inc201 North Breazeale Avenue, Mount Olive, NC 28365
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

THOMAS SCOTT DRAUGHON M.D.
Family Medicine
201 N BREAZEALE AVE
MOUNT OLIVE, NC 28365
Wayne County (919) 658-4954
STEPHEN DOUGLAS FAIRCHILD PA-C
Physician Assistant
201 N BREAZEALE AVE
MOUNT OLIVE, NC 28365
Wayne County (919) 658-4954
PEGGIE ROSE PARKS PA-C
Physician Assistant
201 N BREAZEALE AVE
MOUNT OLIVE, NC 28365
Wayne County (919) 658-4954
MT OLIVE FAMILY MEDICINE CENTER INC
Family Medicine
201 N BREAZEALE AVE
MOUNT OLIVE, NC 28365
Wayne County (919) 658-4954
JEFFREY G HARRISON PA-C
Physician Assistant (Medical)
201 N BREAZEALE AVE
MOUNT OLIVE, NC 28365
Wayne County (919) 658-4954
LABORATORY CORPORATION OF AMERICA HOLDINGS
Clinical Medical Laboratory
201 N BREAZEALE AVE
MOUNT OLIVE, NC 28365
Wayne County (919) 658-5622
DR. VINCENT PAUL WILSON M.D.
Family Medicine
201 N BREAZEALE AVE
MOUNT OLIVE, NC 28365
Wayne County (919) 658-4954
REBECCA LAVERICK LAT ATC
Specialist/Technologist (Athletic Trainer)
201 N BREAZEALE AVE
MOUNT OLIVE, NC 28365
Wayne County (919) 658-4954

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mt. Olive Family Medicine Center's NPI number?

The NPI number for Mt. Olive Family Medicine Center is 1639491038. It was assigned to this organization in the NPPES registry on February 26, 2010.

Where is Mt. Olive Family Medicine Center located?

Mt. Olive Family Medicine Center is located at 201 N Breazeale Ave, Mount Olive, NC 28365. The listed phone number is (919) 658-4954.

What is Mt. Olive Family Medicine Center's specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

Does Mt. Olive Family Medicine Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D0695267) is associated with this NPI, valid through October 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mt. Olive Family Medicine Center was last updated on October 23, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.