Healthcare Provider Details

I. General information

NPI: 1508117185
Provider Name (Legal Business Name): CAMPBELL UNIVERSITY HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 TT LANIER ST
BUIES CREEK NC
27506
US

IV. Provider business mailing address

PO BOX 565
BUIES CREEK NC
27506-0565
US

V. Phone/Fax

Practice location:
  • Phone: 910-893-1562
  • Fax: 910-893-1559
Mailing address:
  • Phone: 910-893-1562
  • Fax: 910-893-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES O ROBERTS
Title or Position: VICE PRESIDENT FOR BUSINESS & TREAS
Credential:
Phone: 910-893-1240