Organization Name: | GOSHEN MEDICAL CENTER, INC. |
NPI Number: | 1265767172 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | REBA W. FUTRELL (EXECUTIVE ASSISTANT CREDENTIALING) |
Mailing Address: | 212 Duplin St Kenansville |
State: | NC US |
Postal Code: | 28349 |
Phone Number: | 9102960790 |
Fax Number: | 9102960879 |
NPI Enumeration Date: | 10/09/2009 |
NPI Last Update Date: | 05/28/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |