Provider Demographics
NPI:1730311648
Name:SAMPSON REGIONAL PROFESSIONAL SERVICES LLC.
Entity Type:Organization
Organization Name:SAMPSON REGIONAL PROFESSIONAL SERVICES LLC.
Other - Org Name:SAMPSON MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLTZGLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-590-8755
Mailing Address - Street 1:607 BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328
Mailing Address - Country:US
Mailing Address - Phone:910-590-8755
Mailing Address - Fax:910-596-6106
Practice Address - Street 1:516 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2602
Practice Address - Country:US
Practice Address - Phone:910-590-0046
Practice Address - Fax:910-590-0048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMPSON REGIONAL PROFESSIONAL SERVICES LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty