Healthcare Provider Details

I. General information

NPI: 1841605995
Provider Name (Legal Business Name): CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 TILGHMAN DR STE C
DUNN NC
28334-5883
US

IV. Provider business mailing address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

V. Phone/Fax

Practice location:
  • Phone: 910-230-7800
  • Fax: 910-615-5626
Mailing address:
  • Phone: 910-615-6910
  • Fax: 910-615-5626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL NAGOWSKI
Title or Position: CEO
Credential:
Phone: 910-615-4000