Healthcare Provider Details

I. General information

NPI: 1982913422
Provider Name (Legal Business Name): SCOTLAND REGIONAL HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24420 MARLBORO STREET
WAGRAM NC
28396-9600
US

IV. Provider business mailing address

PO BOX 602458
CHARLOTTE NC
28260-2458
US

V. Phone/Fax

Practice location:
  • Phone: 919-369-3136
  • Fax: 910-369-4756
Mailing address:
  • Phone: 910-369-3136
  • Fax: 910-369-4756

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: MATHEW DAVID PRACHT
Title or Position: TREASURER
Credential:
Phone: 910-291-7920