1639294309 NPI number — GOSHEN MEDICAL CENTER INCORPORATED

Table of content: (NPI 1639294309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639294309 NPI number — GOSHEN MEDICAL CENTER INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOSHEN MEDICAL CENTER INCORPORATED
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:
Provider Other Organization Name Type Code:
6
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:
1639294309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 187
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAISON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28341-0187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-267-0421
Provider Business Mailing Address Fax Number:
910-267-0441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 CROSSOVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEULAVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28518-8801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-298-3125
Provider Business Practice Location Address Fax Number:
910-267-8980
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
910-267-8252

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 344595A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014VE . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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