Provider Demographics
NPI:1124552310
Name:SCOTLAND MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:SCOTLAND MEMORIAL HOSPITAL INC
Other - Org Name:WOLONICK FAMILY PRACTICE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LUCIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STONGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-291-7547
Mailing Address - Street 1:PO BOX 604093
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4093
Mailing Address - Country:US
Mailing Address - Phone:910-291-7000
Mailing Address - Fax:910-291-7180
Practice Address - Street 1:106 MCALPINE LN
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4637
Practice Address - Country:US
Practice Address - Phone:910-277-8044
Practice Address - Fax:910-277-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343466Medicaid