Active NPI
Long Beach Family Medical Center
- Primary Care Clinic/Center
- Oak Island, NC
National Provider Identifier
1295715076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Clinic/Center
- License
- 39512
- Legal business name
- LONG BEACH FAMILY MEDICAL CENTER
- Practice address
- 4700 E Oak Island Dr
Suite F
Oak Island, NC 28465-5200 - Phone
- (910) 278-3500
- Fax
- (910) 278-7233
- NPI assigned
- Jan 18, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. George Thomas Holland, M. D.
- Title
- Physician
- Phone
- (910) 278-3500
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Legal Medicine | 173000000X | 0039512 | NC | |
| Primary Care Clinic/Center | 261QP2300X | 39512 | NC | Primary |
Addresses
Primary practice location
4700 E Oak Island Dr
Suite F
Oak Island, NC 28465-5200
Mailing address
2006 Robert Ruark Dr
S E
Southport, NC 28461-2652
Phone (910) 457-0595
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 207Q00000X | Other | NC | MEDICARE TAXOMONY |
| 207Q00000X | Other | NC | MEDICAID TAXOMONY |
| 8943093 | Medicaid | NC |
National Provider Directory
National Provider DirectoryLocations
4700 E Oak Island Dr
Ste F
Oak Island, NC 28465
Phone (910) 278-3500
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1219622400000",
"number": "1295715076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2006 ROBERT RUARK DR",
"address_2": "S E",
"city": "SOUTHPORT",
"state": "NC",
"postal_code": "284612652",
"telephone_number": "910-457-0595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 E OAK ISLAND DR",
"address_2": "SUITE F",
"city": "OAK ISLAND",
"state": "NC",
"postal_code": "284655200",
"telephone_number": "910-278-3500",
"fax_number": "910-278-7233"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LONG BEACH FAMILY MEDICAL CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-01-18",
"last_updated": "2008-08-25",
"status": "A",
"authorized_official_last_name": "HOLLAND",
"authorized_official_first_name": "GEORGE",
"authorized_official_middle_name": "THOMAS",
"authorized_official_title_or_position": "PHYSICIAN",
"authorized_official_telephone_number": "910-278-3500",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M. D."
},
"taxonomies": [
{
"code": "173000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Legal Medicine",
"state": "NC",
"license": "0039512",
"primary": false
},
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "NC",
"license": "39512",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE TAXOMONY",
"identifier": "207Q00000X",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID TAXOMONY",
"identifier": "207Q00000X",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8943093",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oak Island, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.