MEDICARE: SCOTLAND MEMORIAL HOSPITAL, INC

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	261QR1300X	Rural Health Clinic/Center		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0262L	OTHER	NC	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417941352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTLAND MEMORIAL HOSPITAL, INC

Provider Business Mailing Address
First Line	:	PO BOX 604093
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-4093
Country	:	US
Telephone Number	:	910-291-7000
Fax Number	:	910-844-5840

Provider Business Practice Location Address
First Line	:	1001 W. MARTIN LUTHER KING JR. DR.
Second Line	:
City	:	MAXTON
State	:	NC
Zip	:	28364
Country	:	US
Telephone Number	:	910-844-4077
Fax Number	:	910-844-5840

Authorized Official
Title or Position	:	CFO
Name	:	LUCIEN STONGE
Credential	:
Telephone Number	:	910-291-7547

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	09/22/2022

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