Healthcare Provider Details

I. General information

NPI: 1669058038
Provider Name (Legal Business Name): ONSLOW AMBULATORY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/31/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 OLD WHITE ST SUITE 1
JACKSONVILLE NC
28546
US

IV. Provider business mailing address

237 OLD WHITE ST
JACKSONVILLE NC
28546
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-4968
  • Fax: 910-577-2916
Mailing address:
  • Phone: 910-577-4968
  • Fax: 910-577-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LIBBY SCOTT
Title or Position: PRACTICE DIRECTOR
Credential:
Phone: 910-577-2533