Provider Demographics
NPI:1538127121
Name:NORTH STATE MEDICAL CENTER PA
Entity Type:Organization
Organization Name:NORTH STATE MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-599-9257
Mailing Address - Street 1:609 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573
Mailing Address - Country:US
Mailing Address - Phone:336-599-9257
Mailing Address - Fax:336-599-2716
Practice Address - Street 1:609 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573
Practice Address - Country:US
Practice Address - Phone:336-599-9257
Practice Address - Fax:336-599-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02948OtherBCBS/NC
NC5911497Medicaid
NC2318295Medicare PIN