Healthcare Provider Details

I. General information

NPI: 1205259298
Provider Name (Legal Business Name): SAMPSON REGIONAL PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
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: 910-590-8710
  • Fax: 910-596-4309
Mailing address:
  • Phone: 910-596-5424
  • Fax: 910-596-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER J COBLE
Title or Position: DIRCTOR OF PRACTICE MANAGEMENT
Credential:
Phone: 910-596-5424