Healthcare Provider Details

I. General information

NPI: 1134634553
Provider Name (Legal Business Name): CUMBERLAND COUNTY HOSPITAL SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340A NORTHEAST BLVD
CLINTON NC
28328-2424
US

IV. Provider business mailing address

PO BOX 40908 ATTN: PFS PROVIDER ENROLLMENT
FAYETTEVILLE NC
28309-0908
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-5379
  • Fax: 910-592-5353
Mailing address:
  • Phone: 910-615-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH B FISER
Title or Position: VP CORPORATE REVENUE CYCLE
Credential:
Phone: 910-615-5572