Provider Demographics
NPI:1700104775
Name:BURGAW MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:BURGAW MEDICAL CENTER, P.C.
Other - Org Name:HAMPSTEAD FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOOTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-259-3377
Mailing Address - Street 1:144 MERCHANTS CIR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-5260
Mailing Address - Country:US
Mailing Address - Phone:910-803-0340
Mailing Address - Fax:910-803-0342
Practice Address - Street 1:144 MERCHANTS CIR STE 100
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-5039
Practice Address - Country:US
Practice Address - Phone:910-803-0340
Practice Address - Fax:910-803-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913552Medicaid
NC5917334Medicaid
NC5917334Medicaid
NC2075674BMedicare PIN
NC5913552Medicaid
NC203728AMedicare PIN