NPIMap

Organization Active NPI

Robeson Health Care Corporation

Doing business as Fairmont Family Dental

  • Federally Qualified Health Center (FQHC)
  • Fairmont, NC
National Provider Identifier
1184490104
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ROBESON HEALTH CARE CORPORATION
Doing business as
Fairmont Family Dental
Practice address
210 S Walnut Street
Fairmont, NC 28340
Phone
(910) 521-2900
Fax
(910) 775-9165
NPI assigned
Nov 30, 2023
Last updated
Nov 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

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

Authorized official

Name
George Timothy Hall
Title
Ceo
Phone
(910) 521-2900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

210 S Walnut Street
Fairmont, NC 28340

Mailing address

60 Commerce Plaza Cir
Pembroke, NC 28372-7386
Phone (910) 521-2900

Other names 1

  • Fairmont Family Dental Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240326002410 NC Part A Provider - Federally Qualified Health Center (FQHC) 1850290693 Practice locations: Fairmont, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184490104. Details of each certification follow.

Federally qualified health center certification: CCN B61032

Legal name
ROBESON HEALTH CARE CORPORATION
Doing business as
FAIRMONT FAMILY DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 26, 2024
Last certification
Mar 26, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 27, 1985 in NC
Enrollment address
210 S Walnut St
Fairmont, NC 28340-1956

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
Robeson Health Care Corporation16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

402 N Pine St
#C
Lumberton, NC 28358
Phone (910) 739-1666

901 N Chestnut St
Lumberton, NC 28358
Phone (910) 618-9912

309 E Wardell Dr
Pembroke, NC 28372
Phone (910) 521-1464

15 Hill Plz
#A
Whiteville, NC 28472
Phone (910) 207-6440

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Henry Junior Shamburger Individual Corporate DirectorSecretary Jul 1, 2019
Michael L Hardin Individual Corporate DirectorVice Chair Jul 1, 2023
George Timothy Hall Individual Corporate OfficerChief Executive Officer Mar 8, 2016
W-2 Managing EmployeeChief Executive Officer Mar 8, 2016
Kristy Lynn Locklear Individual Corporate OfficerChief Financial Officer Mar 8, 2016
W-2 Managing EmployeeChief Financial Officer Mar 8, 2016
Denise Hunt Individual Corporate DirectorTreasurer Jul 1, 2019
Sheena Marie Hunt Individual Corporate DirectorChair Jul 1, 2019

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1701302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701302400000",
    "number": "1184490104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 COMMERCE PLAZA CIR",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283727386",
            "telephone_number": "910-521-2900",
            "fax_number": "910-775-9165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S WALNUT STREET",
            "city": "FAIRMONT",
            "state": "NC",
            "postal_code": "28340",
            "telephone_number": "910-521-2900",
            "fax_number": "910-775-9165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBESON HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-30",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-28",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "TIMOTHY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-521-2900"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairmont Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairmont, NC

Sources for this page

Verify at the official NPI Registry.