Provider Demographics
NPI:1568781862
Name:BURGAW MEDICAL CENTER
Entity Type:Organization
Organization Name:BURGAW MEDICAL CENTER
Other - Org Name:BURGAW MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOOTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-259-3377
Mailing Address - Street 1:311 S MCNEIL ST
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-5015
Mailing Address - Country:US
Mailing Address - Phone:910-259-3377
Mailing Address - Fax:910-259-3013
Practice Address - Street 1:311 S MCNEIL ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5015
Practice Address - Country:US
Practice Address - Phone:910-259-3377
Practice Address - Fax:910-259-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8976548Medicaid
NCC86835Medicare UPIN
NC203728Medicare PIN