Provider Demographics
NPI:1508183633
Name:COLUMBUS REGIONAL PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:COLUMBUS REGIONAL PHYSICIANS NETWORK
Other - Org Name:SOUTH COLUMBUS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-641-3677
Mailing Address - Street 1:500 JEFFERSON STREET
Mailing Address - Street 2:ATTN: DEBRA SNIDER, DIRECTOR PHYSICIAN NETWORK
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3634
Mailing Address - Country:US
Mailing Address - Phone:910-641-3677
Mailing Address - Fax:
Practice Address - Street 1:14508 JAMES B WHITE HWY S
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463-8358
Practice Address - Country:US
Practice Address - Phone:910-653-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty