Healthcare Provider Details

I. General information

NPI: 1891930376
Provider Name (Legal Business Name): ONSLOW AMBULATORY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OFFICE PARK DR
JACKSONVILLE NC
28546-3219
US

IV. Provider business mailing address

241 NEW RIVER DR
JACKSONVILLE NC
28540-5928
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-2319
  • Fax: 910-353-6870
Mailing address:
  • Phone: 910-577-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number200200995
License Number StateNC

VIII. Authorized Official

Name: PENNEY BURLINGAME
Title or Position: VICE PRESIDENT
Credential:
Phone: 910-577-2605