Provider Demographics
NPI:1417941352
Name:SCOTLAND MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:SCOTLAND MEMORIAL HOSPITAL, INC
Other - Org Name:MAXTON 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:910-844-5840
Practice Address - Street 1:1001 W. MARTIN LUTHER KING JR. DR.
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364
Practice Address - Country:US
Practice Address - Phone:910-844-4077
Practice Address - Fax:910-844-5840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34-3987Medicaid
NC0262LOtherBCBS
SCNPA922Medicaid
NC235106DMedicare PIN
NC0262LOtherBCBS