Healthcare Provider Details

I. General information

NPI: 1326443870
Provider Name (Legal Business Name): GOSHEN MEDICAL CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ADAIR DR STE C
GOLDSBORO NC
27530-4516
US

IV. Provider business mailing address

444 SW CENTER ST PO BOX 187
FAISON NC
28341-8820
US

V. Phone/Fax

Practice location:
  • Phone: 919-648-4437
  • Fax: 855-269-1567
Mailing address:
  • Phone: 910-267-0421
  • Fax: 910-267-8683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: REBECCA M BROWN
Title or Position: CREDENTIALING
Credential:
Phone: 910-267-8252