Basic Information
| Provider Information | |||||||||
| NPI: | 1942394218 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LUMBERTON CLINIC OF SURGERY, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 N. ELM ST. | ||||||||
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| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102723051 | ||||||||
| FaxNumber: | 9107383764 | ||||||||
| Practice Location | |||||||||
| Address1: | 2604 N. ELM ST. | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107384276 | ||||||||
| FaxNumber: | 9107384277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | DOCTOR | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D | ||||||||
| AuthorizedOfficialTelephone: | 9107384276 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 7217 | NC | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.