OrganizationFunderburk MdInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address250 Executive Park Blvd, Winston Salem, NC 27103-1534(336) 659-9440PECOS EnrollmentBased on the most recent information from CMS, provider Funderburk Md 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 ID1841460326Provider TypeOrganizationFull NameFunderburk MdSubpartNoEnumeration Date3/11/2008Last Updated3/11/2008Contact InformationPractice LocationPractice Address250 Executive Park Blvd, Winston Salem, NC 27103-1534Phone(336) 659-9440Fax(336) 659-9845Mailing LocationMailing Address250 Executive Park Blvd, Winston Salem, NC 27103-1534Phone(336) 659-9440Fax(336) 659-9845Authorized OfficialNameFunderburk, Amon (Owner)Phone(336) 659-9440Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense15068North CarolinaProvider IdentifiersIDDescriptionIssuerID34172DescriptionOtherIssuerBCBSNCNorth CarolinaID8934172DescriptionMedicaidIssuerUnlistedNorth Carolina