Provider Demographics
NPI:1164726105
Name:SCOTLAND REGIONAL HEALTH NETWORK
Entity Type:Organization
Organization Name:SCOTLAND REGIONAL HEALTH NETWORK
Other - Org Name:SCOTLAND SURGICAL AND GI ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PRACHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-291-7920
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:704-631-0002
Mailing Address - Fax:
Practice Address - Street 1:500 LAUCHWOOD DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5501
Practice Address - Country:US
Practice Address - Phone:910-277-9164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTLAND REGIONAL HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-05
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164726105Medicaid
SCNPB423Medicaid
NC5917315Medicaid
SCNPB423Medicaid