Provider Demographics
NPI:1760706154
Name:SAMPSON REGIONAL PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:SAMPSON REGIONAL PROFESSIONAL SERVICES LLC
Other - Org Name:JOHN ROBERTS MD GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-592-8511
Mailing Address - Street 1:603 BEAMAN ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2650
Mailing Address - Country:US
Mailing Address - Phone:910-590-8000
Mailing Address - Fax:910-590-8002
Practice Address - Street 1:603 BEAMAN ST
Practice Address - Street 2:SUITE 501
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2650
Practice Address - Country:US
Practice Address - Phone:910-590-8000
Practice Address - Fax:910-590-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8972188Medicaid
NCP00898016OtherRR MEDICARE
NC72188OtherBCBS
NCP00898016OtherRR MEDICARE