Provider Demographics
NPI:1679718316
Name:GOSHEN MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:GOSHEN MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT/CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBA
Authorized Official - Middle Name:W
Authorized Official - Last Name:FUTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-267-1942
Mailing Address - Street 1:109 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NC
Mailing Address - Zip Code:27830-8710
Mailing Address - Country:US
Mailing Address - Phone:919-242-4382
Mailing Address - Fax:919-242-4526
Practice Address - Street 1:109 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NC
Practice Address - Zip Code:27830-8710
Practice Address - Country:US
Practice Address - Phone:919-242-4382
Practice Address - Fax:919-242-4526
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOSHEN MEDICAL CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-10
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)