Provider Demographics
NPI:1922376029
Name:SCOTLAND MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:SCOTLAND MEMORIAL HOSPITAL, INC
Other - Org Name:MCCOLL FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRACHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-291-7920
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-1847
Mailing Address - Country:US
Mailing Address - Phone:910-291-7171
Mailing Address - Fax:910-276-0571
Practice Address - Street 1:500 LAUCHWOOD DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5501
Practice Address - Country:US
Practice Address - Phone:910-291-7000
Practice Address - Fax:910-276-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790160LMedicaid