Provider Demographics
NPI:1902188964
Name:LONG BEACH FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:LONG BEACH FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:910-278-3500
Mailing Address - Street 1:4700 E OAK ISLAND DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-5257
Mailing Address - Country:US
Mailing Address - Phone:910-278-3500
Mailing Address - Fax:910-278-7233
Practice Address - Street 1:4700 E OAK ISLAND DR
Practice Address - Street 2:SUITE F
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28465-5257
Practice Address - Country:US
Practice Address - Phone:910-278-3500
Practice Address - Fax:910-278-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200701097251B00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200701097OtherSTATE LICENSE