NPIMap

Organization Active NPI

Private Diagnostic Clinic, PLLC

  • Medical Oncology Physician
  • Lumberton, NC
National Provider Identifier
1114073160
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
Legal business name
PRIVATE DIAGNOSTIC CLINIC, PLLC
Practice address
1200 Pine Run Dr
Lumberton, NC 28358-2180
Phone
(910) 671-5730
NPI assigned
Jan 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2022

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

Authorized official

Name
Christopher Thomas Frederick
Title
Cfo
Phone
(919) 613-7762

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RX0202X NC Primary

Addresses

Primary practice location

1200 Pine Run Dr
Lumberton, NC 28358-2180

Mailing address

PO Box 110566
Durham, NC 27709-5566
Phone (919) 620-4855

Other identifiers 2

IdentifierTypeStateIssuer
790108FMedicaidNC
0108FOtherNCBCBS

Other names 1

  • Lumberton Oncology Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652400000000",
    "number": "1114073160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110566",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277095566",
            "telephone_number": "919-620-4855",
            "fax_number": "919-620-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 PINE RUN DR",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283582180",
            "telephone_number": "910-671-5730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE DIAGNOSTIC CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "919-613-7762"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790108F",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0108F",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lumberton Oncology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Lumberton Oncology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lumberton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; 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.