Provider Demographics
NPI:1194128991
Name:GOSHEN MEDICAL CENTER INCORPORATED
Entity type:Organization
Organization Name:GOSHEN MEDICAL CENTER INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-267-8252
Mailing Address - Street 1:444 SW CENTER ST
Mailing Address - Street 2:
Mailing Address - City:FAISON
Mailing Address - State:NC
Mailing Address - Zip Code:28341-8820
Mailing Address - Country:US
Mailing Address - Phone:910-267-0421
Mailing Address - Fax:910-267-8989
Practice Address - Street 1:104 ADAIR DR # A
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4516
Practice Address - Country:US
Practice Address - Phone:919-648-4435
Practice Address - Fax:910-267-8932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOSHEN MEDICAL CENTER INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-07
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)