Sam/Outreach Program

Primary specialty

SpecialistTaxonomy code 174400000X

License

MHL-055-114 Issued in NC

Legal business name

SAM/OUTREACH PROGRAM

Practice address

114 E Main St
Ste. B
Lincolnton, NC 28092-2725

Phone

(704) 740-6512

Fax

(704) 735-4995

NPI assigned

Dec 10, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Rosalind Terrelle Bynum

Title

Executive Director

Phone

(704) 740-6512

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260403200000",
    "number": "1003145665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1710",
            "city": "LINCOLNTON",
            "state": "NC",
            "postal_code": "280931710",
            "telephone_number": "704-740-6512",
            "fax_number": "704-735-4995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 E MAIN ST",
            "address_2": "STE. B",
            "city": "LINCOLNTON",
            "state": "NC",
            "postal_code": "280922725",
            "telephone_number": "704-740-6512",
            "fax_number": "704-735-4995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM/OUTREACH PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-10",
        "last_updated": "2009-12-10",
        "status": "A",
        "authorized_official_last_name": "BYNUM",
        "authorized_official_first_name": "ROSALIND",
        "authorized_official_middle_name": "TERRELLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-740-6512",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "MHL-055-114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Lincolnton, NC
• Providers in Lincolnton, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.