Basic Information
Provider Information | |||||||||
NPI: | 1598143620 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SCOTLAND MEMORIAL HOSPITAL, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MARLBORO SURGICAL ASSOCIATES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 2257 | ||||||||
Address2: |   | ||||||||
City: | LAURINBURG | ||||||||
State: | NC | ||||||||
PostalCode: | 283532257 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9102762704 | ||||||||
FaxNumber: | 9102760571 | ||||||||
Practice Location | |||||||||
Address1: | 1007 CHERAW ST | ||||||||
Address2: |   | ||||||||
City: | BENNETTSVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 295122422 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8435350939 | ||||||||
FaxNumber: | 8435350951 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/08/2015 | ||||||||
LastUpdateDate: | 08/31/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | STONGE | ||||||||
AuthorizedOfficialFirstName: | LUCIEN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 9102917547 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/31/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |   |
No ID Information.