Healthcare Provider Details

I. General information

NPI: 1760706154
Provider Name (Legal Business Name): SAMPSON REGIONAL PROFESSIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 BEAMAN ST SUITE 501
CLINTON NC
28328-2650
US

IV. Provider business mailing address

603 BEAMAN ST SUITE 501
CLINTON NC
28328-2650
US

V. Phone/Fax

Practice location:
  • Phone: 910-590-8000
  • Fax: 910-590-8001
Mailing address:
  • Phone: 910-590-8000
  • Fax: 910-590-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID MASTERSON
Title or Position: CEO
Credential:
Phone: 910-592-8511