Provider Demographics
NPI:1073749131
Name:SAMPSON REGIONAL PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:SAMPSON REGIONAL PROFESSIONAL SERVICES LLC
Other - Org Name:PRIORITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-592-8511
Mailing Address - Street 1:PO BOX 890315
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0315
Mailing Address - Country:US
Mailing Address - Phone:910-592-8511
Mailing Address - Fax:910-592-5461
Practice Address - Street 1:522 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2602
Practice Address - Country:US
Practice Address - Phone:910-596-4262
Practice Address - Fax:910-592-5461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMPSON REGIONAL PROFESSIONAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-03
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty