Basic Information
| Provider Information | |||||||||
| NPI: | 1720046980 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN WAYNE MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2280 US HIGHWAY 70 W | ||||||||
| Address2: | |||||||||
| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275309546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197351400 | ||||||||
| FaxNumber: | 9195810353 | ||||||||
| Practice Location | |||||||||
| Address1: | 2280 US HIGHWAY 70 W | ||||||||
| Address2: | |||||||||
| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275309546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197351400 | ||||||||
| FaxNumber: | 9195810353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CROOM | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9197351400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0050X | 32555 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical |
No ID Information.