Provider Demographics
NPI:1790976496
Name:2ND MARINE DIVISION
Entity Type:Organization
Organization Name:2ND MARINE DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-451-8372
Mailing Address - Street 1:1802 HARRIETTE DR
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-6722
Mailing Address - Country:US
Mailing Address - Phone:252-522-4895
Mailing Address - Fax:
Practice Address - Street 1:FRENCH CREEK GAS, CLR 27, 2ND MLG
Practice Address - Street 2:
Practice Address - City:CAMP LEJUENE
Practice Address - State:NC
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:910-451-5125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1102XAmbulatory Health Care FacilitiesClinic/CenterMilitary Outpatient Operational (Transportable) Component