Basic Information
| Provider Information | |||||||||
| NPI: | 1174246821 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GOSHEN MEDICAL CENTER INCORPORATED | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GMC PHARMACY AT DUNN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 187 | ||||||||
| Address2: | |||||||||
| City: | FAISON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283410187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102672042 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 801 TILGHMAN DR | ||||||||
| Address2: | |||||||||
| City: | DUNN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283345891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107663313 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2022 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | BOUNDS | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9102671237 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | N | 193200000X MULTI-SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist | 261QF0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 333600000X | N | Suppliers | Pharmacy | 3336C0002X | N | Suppliers | Pharmacy | Clinic Pharmacy | 3336M0002X | N | Suppliers | Pharmacy | Mail Order Pharmacy | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.