Provider Demographics
NPI:1598943813
Name:GOLDSBORO MEDICAL CENTER, P.A.
Entity Type:Organization
Organization Name:GOLDSBORO MEDICAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUGOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-739-9599
Mailing Address - Street 1:2400 WAYNE MEMORIAL DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1749
Mailing Address - Country:US
Mailing Address - Phone:919-739-9599
Mailing Address - Fax:919-739-5535
Practice Address - Street 1:2400 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE J
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1789
Practice Address - Country:US
Practice Address - Phone:919-739-9599
Practice Address - Fax:919-739-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600902174400000X, 207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC562122497OtherTAX ID#
NC8929352Medicaid
NC29352OtherBLUE CROSS
NC147TCOtherBLUE CROSS BLUE SHIELD
NC147TCOtherBLUE CROSS BLUE SHIELD
NCG35254Medicare UPIN
NC562122497OtherTAX ID#
NC8929352Medicaid
NC2228004CMedicare PIN