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General NPI Number Information
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NPI Number | 1073749131
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Entity Type | Organization
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Legal Business Name | SAMPSON REGIONAL PROFESSIONAL SERVICES LLC
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 522 BEAMAN ST
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City | CLINTON
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State | NC
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Zip | 28328-2602
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Country | US
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Telephone | 910-596-4262
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Fax | 910-592-5461
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Provider Business Mailing Address
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Address Line | PO BOX 890315
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City | CHARLOTTE
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State | NC
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Zip | 28289-0315
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Country | US
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Telephone | 910-592-8511
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Fax | 910-592-5461
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Authorized Official
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Title or Position | VP/CHIEF FINANCIAL OFFICER
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Name | MR. GERALD HEINZMAN
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Credential |
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Telephone | 910-592-8511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 99999
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License Number State | NC
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