Goldsboro Wellness Center PA

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

30306 Issued in NC

Legal business name

GOLDSBORO WELLNESS CENTER PA

Doing business as

Goldsboro Wellness Center

Practice address

2600 US Highway 70 W
Goldsboro, NC 27530-7779

Phone

(919) 739-4808

NPI assigned

Mar 11, 2014

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

VP of Operations

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Other names 1

• Goldsboro Wellness Center Doing business as

Part of

Tri - State Medical Group Inc

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shannon R. Jimenez, D.O.

  • Family Medicine Physician
  • Goldsboro, NC
  • NPI 1568552628
  NPD

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

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394582400000",
    "number": "1376969550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 US HIGHWAY 70 W",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275307779",
            "telephone_number": "919-739-4808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDSBORO WELLNESS CENTER PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2014-03-11",
        "last_updated": "2014-03-12",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NC",
            "license": "30306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goldsboro Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lester Osmar Gopar, DDS
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• Non-Pharmacy Dispensing Site in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Non-Pharmacy Dispensing Site in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; 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.