Provider Demographics
NPI:1891789970
Name:SCOTLAND MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:SCOTLAND MEMORIAL HOSPITAL, INC
Other - Org Name:WAGRAM FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LUCIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STONGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-291-7547
Mailing Address - Street 1:24420 MARLBORO ST
Mailing Address - Street 2:
Mailing Address - City:WAGRAM
Mailing Address - State:NC
Mailing Address - Zip Code:28396-9600
Mailing Address - Country:US
Mailing Address - Phone:910-369-3136
Mailing Address - Fax:910-369-4756
Practice Address - Street 1:24420 MARLBORO ST
Practice Address - Street 2:
Practice Address - City:WAGRAM
Practice Address - State:NC
Practice Address - Zip Code:28396-9600
Practice Address - Country:US
Practice Address - Phone:910-369-3136
Practice Address - Fax:910-369-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07171OtherBCBS
NC89018PZMedicaid
NC891261TMedicaid
SCNPB192Medicaid
NC891261TMedicaid