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General NPI Number Information
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NPI Number | 1851481089
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Entity Type | Organization
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Legal Business Name | STEPHEN C PUGH MEMORIAL CLINIC
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | WEEKSVILLE ROAD BLDG 128
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City | ELIZABETH CITY
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State | NC
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Zip | 27909
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Country | US
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Telephone | 252-335-6460
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Fax | 252-335-6255
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Provider Business Mailing Address
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Address Line | WEEKSVILLE ROAD BLDG 128
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City | ELIZABETH CITY
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State | NC
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Zip | 27909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | TINA STARLING
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Credential | CWO
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Telephone | 252-335-6527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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