Provider Demographics
NPI:1831185321
Name:SAMPSON MEDICAL SERVICES PA
Entity type:Organization
Organization Name:SAMPSON MEDICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP C OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP C
Authorized Official - Phone:910-596-2400
Mailing Address - Street 1:408 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2312
Mailing Address - Country:US
Mailing Address - Phone:910-596-2400
Mailing Address - Fax:910-596-2502
Practice Address - Street 1:408 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2312
Practice Address - Country:US
Practice Address - Phone:910-596-2400
Practice Address - Fax:910-596-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200386207Q00000X
NC207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000106Medicaid
2342377Medicare ID - Type Unspecified