MEDICARE: GOSHEN MEDICAL CENTER INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1144170283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOSHEN MEDICAL CENTER INCORPORATED

Provider Business Mailing Address
First Line	:	PO BOX 187
Second Line	:
City	:	FAISON
State	:	NC
Zip	:	28341-0187
Country	:	US
Telephone Number	:	910-267-0421
Fax Number	:	855-705-0022

Provider Business Practice Location Address
First Line	:	1444 S 17TH ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-6436
Country	:	US
Telephone Number	:	910-793-4311
Fax Number	:	910-973-4322

Authorized Official
Title or Position	:	CEO
Name	:	GREGORY BOUNDS
Credential	:
Telephone Number	:	910-267-1942

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	06/15/2026

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