Look up the most recent NPI and PECOS records

Logan Mock

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

215 Brightwater Dr, Lillington, NC 27546-5156

PECOS Enrollment

Based on the most recent information from CMS, provider Logan Mock is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1578180006
Provider Type
Individual
Full Name
Mock, Logan
Credential
PA

Gender
Male
Sole Proprietor
Yes
Enumeration Date
6/30/2020
Last Updated
11/20/2024

Contact Information

Practice Location

215 Brightwater Dr, Lillington, NC 27546-5156

(704) 765-2578

Unlisted Fax

Mailing Location

200 Queens Rd Ste 400, Charlotte, NC 28204-3264

(704) 765-2578

(707) 333-3397

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Logan Mock

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Speight, Jamie L

Cothran, Ashley L

Adeyemi, Norah

Eaton, Karley

Rushton, Samantha Joelle

Sura, Kavita

Nguyen, Jasmine

Farawi, Dania Mahmoud

Heavner, Aydan Luke

Irwin, Hope