Basic Information
| Provider Information | |||||||||
| NPI: | 1548711963 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOSHEN MEDICAL CENTER INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 SW CENTER ST | ||||||||
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| City: | FAISON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283418820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102670421 | ||||||||
| FaxNumber: | 8559969090 | ||||||||
| Practice Location | |||||||||
| Address1: | 4654 LONG BEACH RD SE | ||||||||
| Address2: | |||||||||
| City: | SOUTHPORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284618799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104570070 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2016 | ||||||||
| LastUpdateDate: | 05/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | BOUNDS | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9102671942 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.