Individual ProviderJack XuInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address186 Kimel Park Dr, Winston Salem, NC 27103-6946(336) 277-2000PECOS EnrollmentBased on the most recent information from CMS, provider Jack Xu is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1790239101Provider TypeIndividualFull NameXu, JackGenderMaleSole ProprietorNoEnumeration Date8/15/2016Last Updated3/22/2023Contact InformationPractice LocationPractice Address186 Kimel Park Dr, Winston Salem, NC 27103-6946Phone(336) 277-2000Fax(336) 277-2050Mailing LocationMailing AddressPO Box 751803, Charlotte, NC 28275-1803Phone(336) 277-2000Fax(336) 277-2050Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense2022-01767North CarolinaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseE-12710Arkansas