Basic Information
| Provider Information | |||||||||
| NPI: | 1760744361 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAMPSON REGIONAL PROFESSIONAL SERVICES, LLC | ||||||||
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| OtherOrganizationName: | SAMPSON SURGICAL SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 BEAMAN ST. | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283282603 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 607 BEAMAN STREET | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283282603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105928511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 08/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | BALLTZGLIER | ||||||||
| AuthorizedOfficialFirstName: | HUNTER | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9105908755 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.