Provider Demographics
NPI:1508986944
Name:SAMPSON REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:SAMPSON REGIONAL MEDICAL CENTER
Other - Org Name:SAMPSON HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HEINZMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-590-8729
Mailing Address - Street 1:607 BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2603
Mailing Address - Country:US
Mailing Address - Phone:910-596-4262
Mailing Address - Fax:910-592-5461
Practice Address - Street 1:508 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2602
Practice Address - Country:US
Practice Address - Phone:910-590-5312
Practice Address - Fax:910-590-5305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMPSON REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-30
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0257251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0075TOtherBCBS
NC3407064Medicaid
NC0075TOtherBCBS