Basic Information
| Provider Information | |||||||||
| NPI: | 1538407036 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GOSHEN MEDICAL CENTER INCORPORATED | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GOSHEN MEDICAL CENTER-WHITEVILLE MOBILE UNIT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 187 | ||||||||
| Address2: | |||||||||
| City: | FAISON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283410187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102670421 | ||||||||
| FaxNumber: | 9102678683 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 WHITEVILLE TOWNE CTR | ||||||||
| Address2: | |||||||||
| City: | WHITEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284724929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102126613 | ||||||||
| FaxNumber: | 9102678986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2013 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | BOUNDS | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9102891416 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.