Healthcare Provider Details

I. General information

NPI: 1912412255
Provider Name (Legal Business Name): CUMBERLAND COUNTY HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340A NORTHEAST BLVD
CLINTON NC
28328-2424
US

IV. Provider business mailing address

PO BOX 40908 ATTN: PFS-PROVIDER ENROLLMENT
FAYETTEVILLE NC
28309-0908
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-5379
  • Fax: 910-592-5353
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH B FISER
Title or Position: VP CORPORATE REVENUE CYCLE
Credential:
Phone: 910-615-5572