Provider Demographics
NPI:1588780902
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:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-592-8511
Mailing Address - Street 1:518 BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2602
Mailing Address - Country:US
Mailing Address - Phone:910-592-8511
Mailing Address - Fax:910-592-5461
Practice Address - Street 1:518 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2602
Practice Address - Country:US
Practice Address - Phone:910-592-8511
Practice Address - Fax:910-592-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232092Medicare PIN