Healthcare Provider Details

I. General information

NPI: 1720046980
Provider Name (Legal Business Name): WESTERN WAYNE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 US HIGHWAY 70 W
GOLDSBORO NC
27530-9546
US

IV. Provider business mailing address

2280 US HIGHWAY 70 W
GOLDSBORO NC
27530-9546
US

V. Phone/Fax

Practice location:
  • Phone: 919-735-1400
  • Fax: 919-581-0353
Mailing address:
  • Phone: 919-735-1400
  • Fax: 919-581-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number32555
License Number StateNC

VIII. Authorized Official

Name: MRS. SUSAN G CROOM
Title or Position: BILLING MANAGER
Credential:
Phone: 919-735-1400