OrganizationIclinic, PaInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address755 Highland Oaks Dr, Suite 202, Winston-Salem, NC 27103-7106(336) 760-0070PECOS EnrollmentBased on the most recent information from CMS, provider Iclinic, Pa does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1316999691Provider TypeOrganizationFull NameIclinic, PaSubpartNoEnumeration Date5/16/2006Last Updated6/18/2009Contact InformationPractice LocationPractice Address755 Highland Oaks Dr, Suite 202, Winston-Salem, NC 27103-7106Phone(336) 760-0070Fax(336) 760-0017Mailing LocationMailing Address755 Highland Oaks Dr, Suite 202, Winston-Salem, NC 27103-7106Phone(336) 760-0070Fax(336) 760-0017Authorized OfficialNameLlibre, Giovanni (Owner)Phone(336) 760-0070Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense9900918North CarolinaProvider IdentifiersIDDescriptionIssuerID016XTDescriptionOtherIssuerBCBS OF NORTH CAROLINANorth CarolinaID5950540DescriptionMedicaidIssuerUnlistedNorth Carolina