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Robeson Health Care Corporation

Organization Active NPI Federally Qualified Health Center (FQHC) · Pembroke, NC

NPI 1508522996 · NPPES record last updated Mar 23, 2022

Key facts

NPI
1508522996
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
ROBESON HEALTH CARE CORPORATION
Practice address
307 E Wardell Dr
Pembroke, NC 28372-7998
Phone
(910) 521-2816
Fax
(910) 521-3583
NPI assigned
Nov 10, 2021
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 15

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

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 15

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 24

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NC

Federally qualified health center certification: CCN 341172

Legal name
ROBESON HEALTH CARE CORPORATION
Doing business as
RHCC MOBILE UNIT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 15, 2021
Last certification
Dec 15, 2021
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Mar 27, 1985 in NC
Enrollment address
307 E Wardell Dr
Pembroke, NC 28372-7998

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 Director Jul 1, 2019
George Timothy Hall
Individual 		Corporate Officer
Chief Executive Officer		 Mar 8, 2016
W-2 Managing Employee
Chief Executive Officer		 Mar 8, 2016
Kristy Lynn Locklear
Individual 		Corporate Officer
Chief Financial Officer		 Mar 8, 2016
W-2 Managing Employee
Chief Financial Officer		 Mar 8, 2016
Denise Hunt
Individual 		Corporate Director Jul 1, 2019
Sheena Marie Hunt
Individual 		Corporate Director Jul 1, 2019
Bobby Townsend
Individual 		Corporate Director Jul 1, 2021

Medicare enrollment records

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…
O20221011002815 NC Part a Provider - Federally Qualified Health Center (FQHC) 1850290693 Practice locations: Pembroke, NC

National Provider Directory

Tax ID family
Robeson Health Care Corporation (16 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

307 E Wardell Dr
Pembroke, NC 28372-7998

Mailing address

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

Other names

  • RHCC MOBILE UNIT Doing business as

Other providers in Pembroke, NC

All providers in Pembroke, NC · Federally Qualified Health Center (FQHC) in North Carolina

Sources for this page

Verify at the official NPI Registry.