Provider Demographics
NPI:1104344183
Name:CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC
Entity type:Organization
Organization Name:CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-615-6700
Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:588 BAILEY RD STE K
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2470
Practice Address - Country:US
Practice Address - Phone:910-615-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMBERLAND COUNTY HOSPITAL SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-30
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty