Provider Demographics
NPI:1477878874
Name:GOSHEN MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:GOSHEN MEDICAL CENTER, INC.
Other - Org Name:CLINTON DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SITE LEADER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-267-0951
Mailing Address - Street 1:908 US HWY 421 N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-0410
Mailing Address - Country:US
Mailing Address - Phone:910-299-0991
Mailing Address - Fax:910-299-0995
Practice Address - Street 1:908 N US HIGHWAY 421
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:910-267-0951
Practice Address - Fax:910-267-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914123Medicaid