Provider Demographics
NPI:1629118625
Name:SCOTLAND MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SCOTLAND MEMORIAL HOSPITAL
Other - Org Name:FOXGLOVE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRACHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-291-7000
Mailing Address - Street 1:812 CANDY PARK RD
Mailing Address - Street 2:SUITE 6101
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28672
Mailing Address - Country:US
Mailing Address - Phone:910-521-1182
Mailing Address - Fax:910-521-1192
Practice Address - Street 1:812 CANDY PARK RD
Practice Address - Street 2:SUITE 6101 FOXGOLVE PLACE
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28672
Practice Address - Country:US
Practice Address - Phone:910-521-1182
Practice Address - Fax:910-521-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty