NPIMap

Organization Active NPI

Shallotte Medical Center Inc

Doing business as Holden Beach Medical Center

  • Family Medicine Physician
  • Supply, NC
National Provider Identifier
1306815741
Registry record updated Feb 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SHALLOTTE MEDICAL CENTER INC
Doing business as
Holden Beach Medical Center
Practice address
2930 Holden Beach Rd
Supply, NC 28462
Phone
(910) 842-5991
Fax
(910) 842-5994
NPI assigned
Mar 17, 2006
Last updated
Feb 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2008

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

Authorized official

Name
Dr. Bernard Leroy Langston III, MDNPI 1821066358
Title
President
Phone
(910) 754-8731

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2930 Holden Beach Rd
Supply, NC 28462

Mailing address

PO Box02561
Holden Beach Medical Center
Shallotte, NC 28459
Phone (910) 842-5991

Other identifiers 1

IdentifierTypeStateIssuer
348940AMedicaidNC

Other names 1

  • Holden Beach Medical Center Doing business as

National Provider Directory

National Provider Directory

Locations

2930 Holden Beach Rd SW
Supply, NC 28462
Phone (910) 842-5991

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1306815741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX02561",
            "address_2": "HOLDEN BEACH MEDICAL CENTER",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "28459",
            "telephone_number": "910-842-5991",
            "fax_number": "910-842-5994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2930 HOLDEN BEACH RD",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "28462",
            "telephone_number": "910-842-5991",
            "fax_number": "910-842-5994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALLOTTE MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-17",
        "last_updated": "2008-02-05",
        "status": "A",
        "authorized_official_last_name": "LANGSTON",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "LEROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-754-8731",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "348940A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holden Beach Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Supply, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.

Verify at the official NPI Registry.