Provider Demographics
NPI:1114479326
Name:GOSHEN MEDICAL CENTER, INCORPORATED
Entity Type:Organization
Organization Name:GOSHEN MEDICAL CENTER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-267-1942
Mailing Address - Street 1:444 SW CENTER ST
Mailing Address - Street 2:
Mailing Address - City:FAISON
Mailing Address - State:NC
Mailing Address - Zip Code:28341-8820
Mailing Address - Country:US
Mailing Address - Phone:910-267-0421
Mailing Address - Fax:855-996-9090
Practice Address - Street 1:630 S MADISON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4130
Practice Address - Country:US
Practice Address - Phone:910-642-7463
Practice Address - Fax:910-642-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)