Provider Demographics
NPI:1669511143
Name:GOLDSBORO PAIN MEDICINE, PLLC
Entity Type:Organization
Organization Name:GOLDSBORO PAIN MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-751-8444
Mailing Address - Street 1:1208 PARKWAY DR STE C
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9432
Mailing Address - Country:US
Mailing Address - Phone:919-751-8444
Mailing Address - Fax:919-751-0890
Practice Address - Street 1:1208 PARKWAY DR STE C
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9432
Practice Address - Country:US
Practice Address - Phone:919-751-8444
Practice Address - Fax:919-751-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107402204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2308597Medicare ID - Type UnspecifiedMEDICARE PRACTICE ID