Provider Demographics
NPI:1801086558
Name:SAMPSON REGIONAL MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:SAMPSON REGIONAL MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:HEINZMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-592-8511
Mailing Address - Street 1:PO BOX 890235
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0235
Mailing Address - Country:US
Mailing Address - Phone:800-919-1190
Mailing Address - Fax:706-737-2272
Practice Address - Street 1:607 BEAMAN ST
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2603
Practice Address - Country:US
Practice Address - Phone:910-592-8511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207LP2900X, 367500000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty