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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1962124974
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	:	910-267-2042
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 DUPLIN ST
Second Line	:
City	:	KENANSVILLE
State	:	NC
Zip	:	28349-9024
Country	:	US
Telephone Number	:	910-296-1811
Fax Number	:	910-296-0862

Authorized Official
Title or Position	:	CEO
Name	:	GREGORY M BOUNDS
Credential	:
Telephone Number	:	910-267-1237

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	09/20/2022

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