Provider Demographics
NPI:1841565447
Name:SCOTLAND REGIONAL HEALTH NETWORK
Entity Type:Organization
Organization Name:SCOTLAND REGIONAL HEALTH NETWORK
Other - Org Name:SCOTLAND GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-355-0648
Mailing Address - Street 1:PO BOX 602589
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2589
Mailing Address - Country:US
Mailing Address - Phone:910-277-4410
Mailing Address - Fax:910-277-4223
Practice Address - Street 1:205 LAUCHWOOD DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4604
Practice Address - Country:US
Practice Address - Phone:910-277-4410
Practice Address - Fax:910-277-4223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTLAND REGIONAL HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-14
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920042Medicaid
SCNPB481Medicaid
NC5920042Medicaid