Healthcare Provider Details

I. General information

NPI: 1679718316
Provider Name (Legal Business Name): GOSHEN MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S SYCAMORE ST
FREMONT NC
27830-8710
US

IV. Provider business mailing address

109 S SYCAMORE ST
FREMONT NC
27830-8710
US

V. Phone/Fax

Practice location:
  • Phone: 919-242-4382
  • Fax: 919-242-4526
Mailing address:
  • Phone: 919-242-4382
  • Fax: 919-242-4526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBA W. FUTRELL
Title or Position: EXECUTIVE ASSISTANT/CREDENTIALING
Credential:
Phone: 910-267-1942