1164500716 NPI number — SAMPSON REGIONAL MEDICAL CENTER

Table of content: (NPI 1164500716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164500716 NPI number — SAMPSON REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMPSON REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAMPSON REGIONAL MEDICAL CENTER ONCOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164500716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 BEAMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28328-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-590-2644
Provider Business Mailing Address Fax Number:
910-592-5461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 BEAMAN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-592-8511
Provider Business Practice Location Address Fax Number:
910-592-5461
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEINZMAN
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
910-592-8511

Provider Taxonomy Codes

  • Taxonomy code: 261QX0203X , with the licence number:  082-0407-A1 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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