Healthcare Provider Details

I. General information

NPI: 1114479326
Provider Name (Legal Business Name): GOSHEN MEDICAL CENTER, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S MADISON ST
WHITEVILLE NC
28472-4130
US

IV. Provider business mailing address

444 SW CENTER ST
FAISON NC
28341-8820
US

V. Phone/Fax

Practice location:
  • Phone: 910-642-7463
  • Fax: 910-642-2668
Mailing address:
  • Phone: 910-267-0421
  • Fax: 855-996-9090

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 BOUNDS
Title or Position: CEO
Credential:
Phone: 910-267-1942