SRC Pending Consult Management

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

26NR09534400 Issued in NJ

Legal business name

SRC PENDING CONSULT MANAGEMENT

Practice address

5250 Maryland Ave
Fort Dix, NJ 08640-5058

Phone

(609) 562-6312

NPI assigned

Nov 4, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Christala Cherry, RN, BSN

Title

Case Manager

Phone

(609) 562-6312

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366433534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 PARIS CT",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013724",
            "telephone_number": "732-267-7737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5250 MARYLAND AVE",
            "city": "FORT DIX",
            "state": "NJ",
            "postal_code": "086405058",
            "telephone_number": "609-562-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRC PENDING CONSULT MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHERRY",
        "authorized_official_first_name": "CHRISTALA",
        "authorized_official_title_or_position": "CASE MANAGER",
        "authorized_official_telephone_number": "609-562-6312",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NJ",
            "license": "26NR09534400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Richard Ross, DMD
• Andrew Sahol, DVM
• Kenneth Harry Schmidt, RPH
• Claudia Nicole Simpson II
• Jonathan Sirkin, MD
• Christine Lee Stinner, RN,BSN
• Melissa Sherona Thompson, PHARM.D
• Rory E Tippit, PA-C
• Walson Medical Support Element
• Scott J Winters, FNP

• All providers in Fort Dix, NJ
• Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.