Healthcare Provider Details

I. General information

NPI: 1508986944
Provider Name (Legal Business Name): SAMPSON REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 BEAMAN ST
CLINTON NC
28328-2602
US

IV. Provider business mailing address

607 BEAMAN ST
CLINTON NC
28328-2603
US

V. Phone/Fax

Practice location:
  • Phone: 910-590-5312
  • Fax: 910-590-5305
Mailing address:
  • Phone: 910-596-4262
  • Fax: 910-592-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC0257
License Number StateNC

VIII. Authorized Official

Name: GERALD THOMAS HEINZMAN JR.
Title or Position: CEO
Credential:
Phone: 910-590-8729