Basic Information
| Provider Information | |||||||||
| NPI: | 1619251766 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAMPSON REGIONAL PROFESSIONAL SERVICES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEWTON GROVE URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 BEAMAN ST | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283282603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105928511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWTON GROVE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283667723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105941063 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2011 | ||||||||
| LastUpdateDate: | 10/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | HEINZMAN | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP/ CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9105928511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.