Healthcare Provider Details

I. General information

NPI: 1801086558
Provider Name (Legal Business Name): SAMPSON REGIONAL MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 BEAMAN ST ANESTHESIA DEPARTMENT
CLINTON NC
28328-2603
US

IV. Provider business mailing address

PO BOX 890235
CHARLOTTE NC
28289-0235
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-8511
  • Fax:
Mailing address:
  • Phone: 800-919-1190
  • Fax: 706-737-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: GERALD T HEINZMAN JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 910-592-8511