NPIMap

Organization Active NPI

Scotland Memorial Hospital Inc

Doing business as Wolonick Family Practice Center

  • Rural Health Clinic/Center
  • Laurinburg, NC
National Provider Identifier
1124552310
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SCOTLAND MEMORIAL HOSPITAL INC
Doing business as
Wolonick Family Practice Center
Practice address
106 McAlpine LN
Laurinburg, NC 28352-4637
Phone
(910) 277-8044
Fax
(910) 277-0036
NPI assigned
Apr 14, 2017
Last updated
Sep 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Authorized official

Name
Lucien Stonge
Title
Cfo
Phone
(910) 291-7547

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

106 McAlpine LN
Laurinburg, NC 28352-4637

Mailing address

PO Box 604093
Charlotte, NC 28260-4093
Phone (910) 291-7000

Other identifiers 1

IdentifierTypeStateIssuer
343466MedicaidNC

Other names 1

  • Wolonick Family Practice Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180117000389 NC Part A Provider - Rural Health Clinic 0648208504 Practice locations: Laurinburg, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124552310. Details of each certification follow.

Rural health clinic certification: CCN 343466

Legal name
SCOTLAND MEMORIAL HOSPITAL, INC
Doing business as
WOLONICK FAMILY PRACTICE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 14, 2018
Last certification
Mar 14, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 26, 1947 in NC
Enrollment address
106 McAlpine LN
Laurinburg, NC 28352-4637
Related CCNs
340008

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Scotland Mem Prof Serv27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Milton Farmer Individual Corporate DirectorTrustee Jan 1, 2009
Gregory Clark Wood Individual Corporate OfficerCeo Apr 1, 2009
Operational/Managerial ControlCeo Apr 1, 2009
Matthew David Pracht Individual Corporate OfficerCfo Apr 1, 2009
Operational/Managerial ControlCfo Apr 1, 2009
David Harling Individual Corporate OfficerVice Chairman Jan 1, 2010
Jane Rogers Individual Corporate OfficerChairman Jan 1, 2010
Bradford Keith Faulkenberry Individual Corporate DirectorTrustee Jan 1, 2016
Tim Brooks Individual Corporate DirectorTrustee Jan 1, 2016
Amy Thompson Individual Corporate OfficerCorporate Secretary Dec 1, 2016
Kyle Chavis Individual Corporate DirectorTrustee Jan 1, 2010
Stephen L Lanuti Individual Corporate DirectorTrustee Jan 1, 2014
Joshua Malcolm Individual Corporate DirectorTrustee Jan 1, 2011
Wilbur Gene Shytle Individual Corporate OfficerTreasurer Jan 1, 2013
Scotland Health Care System Organization, Laurinburg, NC Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2017 100%
Robert N Hinson Individual Corporate DirectorTrustee Jan 1, 2014
Rebecca Hughes Individual Corporate DirectorTrustee Jan 1, 2014
Charlotte-Mecklenburg Hospital Authority Organization, Charlotte, NC Operational/Managerial Control Apr 1, 2009
Henry Allen McLaurin Individual Corporate DirectorTrustee Jan 1, 2013

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Marlboro Family Practice and Urgent CareBennettsville, SC, CCN 423461 Rural health clinic Operational/Managerial Control Dec 1, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1492128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1124552310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604093",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282604093",
            "telephone_number": "910-291-7000",
            "fax_number": "910-291-7180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 MCALPINE LN",
            "city": "LAURINBURG",
            "state": "NC",
            "postal_code": "283524637",
            "telephone_number": "910-277-8044",
            "fax_number": "910-277-0036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTLAND MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-14",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "STONGE",
        "authorized_official_first_name": "LUCIEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "910-291-7547"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343466",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wolonick Family Practice Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wolonick Family Practice Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurinburg, NC

Sources for this page

Verify at the official NPI Registry.