Provider Demographics
NPI:1619251766
Name:SAMPSON REGIONAL PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:SAMPSON REGIONAL PROFESSIONAL SERVICES LLC
Other - Org Name:NEWTON GROVE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/ CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-592-8511
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:910-592-8511
Mailing Address - Fax:
Practice Address - Street 1:301 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTON GROVE
Practice Address - State:NC
Practice Address - Zip Code:28366-7723
Practice Address - Country:US
Practice Address - Phone:910-594-1063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care