Healthcare Provider Details

I. General information

NPI: 1992799308
Provider Name (Legal Business Name): MEDICAL SPECIALISTS' CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4384 FAYETTEVILLE RD
LUMBERTON NC
28358-2677
US

IV. Provider business mailing address

4384 FAYETTEVILLE RD
LUMBERTON NC
28358-2677
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-1141
  • Fax: 910-738-6011
Mailing address:
  • Phone: 910-738-1141
  • Fax: 910-738-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9700753
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9601101
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25596
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number26135
License Number StateNC

VIII. Authorized Official

Name: DR. SADANAND HEDGE
Title or Position: PRESIDENT
Credential: MD
Phone: 910-738-1141