Healthcare Provider Details

I. General information

NPI: 1851481089
Provider Name (Legal Business Name): STEPHEN C PUGH MEMORIAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEEKSVILLE ROAD BLDG 128
ELIZABETH CITY NC
27909
US

IV. Provider business mailing address

WEEKSVILLE ROAD BLDG 128
ELIZABETH CITY NC
27909
US

V. Phone/Fax

Practice location:
  • Phone: 252-335-6460
  • Fax: 252-335-6255
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TINA STARLING
Title or Position: CLINIC ADMINISTRATOR
Credential: CWO
Phone: 252-335-6527