Healthcare Provider Details

I. General information

NPI: 1750407128
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: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4654 LONG BEACH RD SE
SOUTHPORT NC
28461-8799
US

IV. Provider business mailing address

PO BOX 187
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 910-267-0421
  • Fax:
Mailing address:
  • Phone: 910-267-0421
  • Fax: 910-267-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: GREGORY BOUNDS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-267-0421