Healthcare Provider Details

I. General information

NPI: 1073638557
Provider Name (Legal Business Name): GOSHEN MEDICAL CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 US HIGHWAY 421
CLINTON NC
28328-0410
US

IV. Provider business mailing address

412 SW CENTER STREET
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-1462
  • Fax: 919-364-8367
Mailing address:
  • Phone: 910-267-1942
  • Fax: 910-267-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: GREGORY M BOUNDS
Title or Position: CEO
Credential:
Phone: 910-267-1237