MEDICARE: CUMBERLAND COUNTY HOSPITAL SYSTEMS, 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	207Q00000X	Family Medicine Physician	H0123	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

General Provider Information

NPI Number	:	1497758023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUMBERLAND COUNTY HOSPITAL SYSTEMS, INC

Provider Business Mailing Address
First Line	:	PO BOX 40908
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28309-0908
Country	:	US
Telephone Number	:	910-609-6448
Fax Number	:	910-609-5070

Provider Business Practice Location Address
First Line	:	6387 RAMSEY ST
Second Line	:	SUITE 100
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-9420
Country	:	US
Telephone Number	:	910-609-3879
Fax Number	:	910-321-6219

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL NAGOWSKI
Credential	:
Telephone Number	:	910-609-6700

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/27/2009

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