Healthcare Provider Details

I. General information

NPI: 1295715076
Provider Name (Legal Business Name): LONG BEACH FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 E OAK ISLAND DR SUITE F
OAK ISLAND NC
28465-5200
US

IV. Provider business mailing address

2006 ROBERT RUARK DR S E
SOUTHPORT NC
28461-2652
US

V. Phone/Fax

Practice location:
  • Phone: 910-278-3500
  • Fax: 910-278-7233
Mailing address:
  • Phone: 910-457-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number0039512
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number39512
License Number StateNC

VIII. Authorized Official

Name: DR. GEORGE THOMAS HOLLAND
Title or Position: PHYSICIAN
Credential: M. D.
Phone: 910-278-3500