Provider Demographics
NPI:1851481089
Name:STEPHEN C PUGH MEMORIAL CLINIC
Entity type:Organization
Organization Name:STEPHEN C PUGH MEMORIAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STARLING
Authorized Official - Suffix:
Authorized Official - Credentials:CWO
Authorized Official - Phone:252-335-6527
Mailing Address - Street 1:WEEKSVILLE ROAD
Mailing Address - Street 2:BLDG 128
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WEEKSVILLE ROAD
Practice Address - Street 2:BLDG 128
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-335-6460
Practice Address - Fax:252-335-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient