Healthcare Provider Details

I. General information

NPI: 1033430475
Provider Name (Legal Business Name): CUMBERLAND COUNTY HOSPITAL SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ROBESON ST SUITE 301
FAYETTEVILLE NC
28305-5551
US

IV. Provider business mailing address

PO BOX 40908
FAYETTEVILLE NC
28309-0908
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-3220
  • Fax: 910-486-2170
Mailing address:
  • Phone: 910-615-6448
  • Fax: 910-615-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberH0213
License Number StateNC

VIII. Authorized Official

Name: MR. MICHAEL NAGOWSKI
Title or Position: CEO
Credential:
Phone: 910-615-6700