Healthcare Provider Details

I. General information

NPI: 1265828990
Provider Name (Legal Business Name): SAMPSON REGIONAL PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 BEAMAN ST
CLINTON NC
28328-2603
US

IV. Provider business mailing address

607 BEAMAN ST
CLINTON NC
28328-2603
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-8511
  • Fax: 910-596-5430
Mailing address:
  • Phone: 910-592-8511
  • Fax: 910-596-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD HEINZMAN
Title or Position: DIRECTOR
Credential: MD
Phone: 910-590-8755