NPIMap

Organization Active NPI

Robeson Health Care Corporation

Doing business as South Robeson Medical Center

  • Federally Qualified Health Center (FQHC)
  • Fairmont, NC
National Provider Identifier
1417914722
Registry record updated Aug 7, 2025
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
South Robeson Medical Center
Practice address
210 S Walnut St
Fairmont, NC 28340-1956
Phone
(910) 628-6711
Fax
(910) 628-5735
NPI assigned
Apr 28, 2006
Last updated
Aug 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2025

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X MHL-078-063 NC
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

210 S Walnut St
Fairmont, NC 28340-1956

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
6005792MedicaidNC
344570 A/CMedicaidNC

Other names 1

  • SOUTH ROBESON MEDICAL CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031231000292 NC Part B Supplier - Clinic/Group Practice 1850290693 Receives reassigned benefits from 27 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Red Springs, NC; Smithfield, NC; Saint Pauls, NC; Pembroke, NC; Maxton, NC; Lumberton, NC; Fairmont, NC; Laurinburg, NC…
O20050512000053 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 1417914722. Details of each certification follow.

Federally qualified health center certification: CCN 341844

Legal name
ROBESON HEALTH CARE CORPORATION
Doing business as
SOUTH ROBESON MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 1, 1993
Last certification
Aug 1, 1993
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 27, 1985 in NC
Enrollment address
210 South Walnut Street
Fairmont, NC 28340

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory

Locations

1212 S Walnut St
Fairmont, NC 28340
Phone (910) 628-6711

210 S Walnut St
Fairmont, NC 28340
Phone (910) 628-6711

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 Director Jul 1, 2019
Sheena Marie Hunt Individual Corporate OfficerBoard Chair Jul 1, 2019

Practitioners & affiliated clinicians

Practitioners 5

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": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754524800000",
    "number": "1417914722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 COMMERCE PLZ",
            "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 ST",
            "city": "FAIRMONT",
            "state": "NC",
            "postal_code": "283401956",
            "telephone_number": "910-628-6711",
            "fax_number": "910-628-5735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBESON HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2025-08-07",
        "certification_date": "2025-08-07",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "TIMOTHY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "910-521-2900"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "MHL-078-063",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005792",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344570 A/C",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH ROBESON MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTH ROBESON MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairmont, NC

Sources for this page

Verify at the official NPI Registry.