OrganizationOwen Drive Surgical Clinic, PaSurgeryAllopathic & Osteopathic PhysiciansPractice Address1617 Owen Dr, Fayetteville, NC 28304-3425(910) 484-0101PECOS EnrollmentBased on the most recent information from CMS, provider Owen Drive Surgical Clinic, 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 11:47 AM.Profile DetailsProvider ID1922104066Provider TypeOrganizationFull NameOwen Drive Surgical Clinic, PaSubpartNoEnumeration Date9/16/2006Last Updated10/7/2009Contact InformationPractice LocationPractice Address1617 Owen Dr, Fayetteville, NC 28304-3425Phone(910) 484-0101Fax(910) 484-2563Mailing LocationMailing AddressPO Box 1615, Etowah, NC 28729-1615Phone(910) 484-0101Fax(910) 484-2563Authorized OfficialNameChaudhuri, Debi (President)Phone(910) 484-0101Provider TaxonomiesCodeDescriptionLicenseCode208600000XPrimaryDescriptionSurgeryAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID89-0255ADescriptionMedicaidIssuerUnlistedNorth CarolinaID0255ADescriptionOtherIssuerBCBSNorth Carolina