Provider Demographics
NPI:1164500716
Name:SAMPSON REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:SAMPSON REGIONAL MEDICAL CENTER
Other - Org Name:SAMPSON REGIONAL MEDICAL CENTER ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
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 1:607 BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2603
Mailing Address - Country:US
Mailing Address - Phone:910-590-2644
Mailing Address - Fax:910-592-5461
Practice Address - Street 1:215 BEAMAN STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328
Practice Address - Country:US
Practice Address - Phone:910-592-8511
Practice Address - Fax:910-592-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC082-0407-A1261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation