Healthcare Provider Details

I. General information

NPI: 1588780902
Provider Name (Legal Business Name): SAMPSON REGIONAL MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 BEAMAN ST
CLINTON NC
28328-2602
US

IV. Provider business mailing address

518 BEAMAN ST
CLINTON NC
28328-2602
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-8511
  • Fax: 910-592-5461
Mailing address:
  • Phone: 910-592-8511
  • Fax: 910-592-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: GERALD HEINZMAN
Title or Position: CFO
Credential:
Phone: 910-592-8511