Provider Demographics
NPI:1417629395
Name:GOSHEN MEDICAL CENTER INCORPORATED
Entity Type:Organization
Organization Name:GOSHEN MEDICAL CENTER INCORPORATED
Other - Org Name:GOSHEN MEDICAL CENTER - CLINTON MOBILE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-267-1237
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:FAISON
Mailing Address - State:NC
Mailing Address - Zip Code:28341-0187
Mailing Address - Country:US
Mailing Address - Phone:910-247-4351
Mailing Address - Fax:
Practice Address - Street 1:906 N US 421 HWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-0410
Practice Address - Country:US
Practice Address - Phone:910-808-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)