Provider Demographics
NPI:1164418232
Name:GOLDSBORO EMERGENCY MEDICAL SPECIALISTS, INC.
Entity Type:Organization
Organization Name:GOLDSBORO EMERGENCY MEDICAL SPECIALISTS, INC.
Other - Org Name:CORRECT LEGAL NAME
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GEER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:919-580-0004
Mailing Address - Street 1:PO BOX K
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533
Mailing Address - Country:US
Mailing Address - Phone:919-580-0004
Mailing Address - Fax:919-580-9099
Practice Address - Street 1:2700 WAYNE MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534
Practice Address - Country:US
Practice Address - Phone:919-731-6060
Practice Address - Fax:919-587-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790149GMedicaid
NC5922111Medicaid
0149GOtherBLUE CROSS BLUE SHIELD
NC5922111Medicaid