Provider Demographics
NPI:1043093339
Name:STEPHENS OUTREACH CENTER, INC
Entity Type:Organization
Organization Name:STEPHENS OUTREACH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-7865
Mailing Address - Street 1:2105 E ELIZABETHTOWN RD # B
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3107
Mailing Address - Country:US
Mailing Address - Phone:910-738-7865
Mailing Address - Fax:910-738-2860
Practice Address - Street 1:13104 NC HIGHWAY 130 E
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-9597
Practice Address - Country:US
Practice Address - Phone:910-535-1423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy