Healthcare Provider Details

I. General information

NPI: 1295113371
Provider Name (Legal Business Name): GOSHEN MEDICAL CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 N US 701 BYPASS
TABOR CITY NC
28463-2705
US

IV. Provider business mailing address

PO BOX 187
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 910-653-1901
  • Fax: 910-267-8935
Mailing address:
  • Phone: 910-267-0421
  • Fax: 910-267-8683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. GREG M BOUNDS
Title or Position: CEO
Credential:
Phone: 910-289-1416