Healthcare Provider Details

I. General information

NPI: 1518280817
Provider Name (Legal Business Name): SAMPSON REGIONAL PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 BEAMAN ST SUITE 100
CLINTON NC
28328-2650
US

IV. Provider business mailing address

607 BEAMAN ST
CLINTON NC
28328-2603
US

V. Phone/Fax

Practice location:
  • Phone: 910-590-8050
  • Fax: 910-590-8051
Mailing address:
  • Phone: 910-592-8511
  • Fax: 910-592-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HUNTER BALLTZGLIER
Title or Position: DIRECTOR
Credential:
Phone: 910-590-8755