Provider Demographics
NPI:1548226004
Name:CUMBERLAND COUNTY HOSPITAL SYSTEM
Entity Type:Organization
Organization Name:CUMBERLAND COUNTY HOSPITAL SYSTEM
Other - Org Name:FERNCREEK GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CAPPM, CMC,CMOM
Authorized Official - Phone:910-485-3880
Mailing Address - Street 1:4140 FERNCREEK DR
Mailing Address - Street 2:SUITE 601
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2563
Mailing Address - Country:US
Mailing Address - Phone:910-485-3880
Mailing Address - Fax:910-485-5341
Practice Address - Street 1:4140 FERNCREEK DR
Practice Address - Street 2:SUITE 601
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2563
Practice Address - Country:US
Practice Address - Phone:910-485-3880
Practice Address - Fax:910-485-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122131208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015VXMedicaid
NC89015VXMedicaid