Healthcare Provider Details

I. General information

NPI: 1700901287
Provider Name (Legal Business Name): GOSHEN MEDICAL CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 NC HIGHWAY 55 W
MOUNT OLIVE NC
28365-8527
US

IV. Provider business mailing address

412 SW CENTER ST
FAISON NC
28341-8820
US

V. Phone/Fax

Practice location:
  • Phone: 919-658-5900
  • Fax: 919-658-0101
Mailing address:
  • Phone: 910-267-0421
  • Fax: 910-267-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGORY M BOUNDS
Title or Position: CEO
Credential:
Phone: 910-267-1237