Healthcare Provider Details

I. General information

NPI: 1538138979
Provider Name (Legal Business Name): SHALLOTTE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SUNSET BLVD N
SUNSET BEACH NC
28468-4340
US

IV. Provider business mailing address

PO BOX 7237 SEASIDE MEDICAL CENTER
SO BRUNSWICK NC
28470
US

V. Phone/Fax

Practice location:
  • Phone: 910-575-3923
  • Fax: 910-575-3926
Mailing address:
  • Phone: 910-575-3923
  • Fax: 910-575-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BERNARD LEROY LANGSTON III
Title or Position: PRESIDENT
Credential: MD
Phone: 910-754-8731