Mark Herzog, PTA

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

3211 Issued in NC

Practice address

924 N Howe St
Southport, NC 28461-3038

Phone

(910) 454-4703

NPI assigned

Apr 10, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447373766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7704 TRAP WAY",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284123450",
            "telephone_number": "910-452-5156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 N HOWE ST",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284613038",
            "telephone_number": "910-454-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "MARK",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NC",
            "license": "3211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Beth Hayes, RPH, MS, CCP
• Rebecca Jane Hedgecock, MA, NCC, LPC
• Marty Lee Hendrick, PHARM D
• Anne Marie Henschel
• Rick J Hernandez, M.D.
• Kaylee Heschke
• Carol H Hester, MA
• Karen Hewett
• William Wesley Hickman, PHARMD
• Brad L Hilaman, MD

• General Acute Care Hospital in Southport, NC
• Providers in Southport, NC by specialty
• General Acute Care Hospital in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.